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Reduced Postoperative Atrial Fibrillation Using Multidrug Prophylaxis
Author(s) -
Ott Richard A.,
Gutfinger Dan E.,
Alimadadian Hossein,
Miller Mark,
Selvan Arthur,
Weinberg David,
Hlapcich Wendy L.,
Tanner Teresa M.
Publication year - 1985
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/j.1540-8175.1985.tb01417.x
Subject(s) - medicine , atrial fibrillation , anesthesia , supraventricular tachycardia , cardiopulmonary bypass , atrial tachycardia , cardiology , incidence (geometry) , surgery , tachycardia , catheter ablation , physics , optics
A bstractBackground: Atrial fibrillation (AFIB) is the most common complication following coronary artery bypass grafting (CABG). Despite three decades of recognition, efforts to reduce the high incidence reported (15%‐30%) have been largely unsuccessful. Reasons for postoperative AFlB are likely multifactorial. As a result, we defined a multidrug prophylaxis based on agents known to be individually effective. This method was applied prospectively to a series of consecutive CABG patients with the goal of reducing the incidence of new‐onset postoperative AFIB. Methods: Isolated CABG with cardiopulmonary bypass was performed on 517 consecutive patients. A rapid recovery protocol emphasizing AFlB multidrug prophylaxis was applied to all patients. All patients received 10 μg of triiodothyronine intraoperatively when the clamp on the aorta was released. Immediately following CABG, parenteral magnesium was administered to assure a serum magnesium > 2.2 mEq/dL. Thyroxine 200 μg was administered parenterally to all patients on postoperative days 1 and 2. Metoprolol (25 mg to 100 mg/day) was begun on all patients after ex‐tubation provided: heart rate > 85 beats/min and systolic blood pressure > 130 mmHg. Parenteral procainamide (12 mg/kg) loading dose, followed by a maintenance dose (2 mg/min), was used for patients who developed premature atrial contractions (> l/min), nonsustained supraventricular tachycardia, or any episodes of atrial fibrillation. All patients also received postoperative digitalization, steroids, and aggressive diuresis. Results: The 30‐day operative mortality was 3.7%. The overall incidence of new‐onset postoperative AFlB was 10.3% (53 patients). There was no major difference in operative mortality (7.5% vs 3.2%, p = 0.231, Parsonnet risk score, or intraoperative variables between AFlB patients and the non‐AFIB patients. Patients presenting with a preoperative acute myocar‐dial infarction (p < 0.051, left main stenosis 2 70% (p < 0.011, and advanced age 2 70 years (p < 0.05) were at increased risk of developing AFIB. The length of stay for patients with AFlB was 9.9 2 9.6 days versus 5.9 2 5.2 days (p < 0.001). Conclusion: Application of a multidrug prophylaxis can reduce postoperative AFlB to a low incidence. Identification of associated clinical features can help predict patients at risk for postoperative AFIB. Additional strategies to target postoperative AFlB may include treatment at the earliest recognition of atrial rhythm instability.