What is the Role of Metabolic Syndrome and Obesity for Postoperative Atrial Fibrillation after Coronary Bypass Grafting?

Year 2019, , 34 - 47, 01.01.2019

Unsal Vural Ahmet Arif Aglar

https://doi.org/10.5455/umj.20191101064746

Abstract

Background: We aimed to determine whether obesity and metabolic syndrome are independent risk factors in postoperative atrial fibrillation and if so, to determine the magnitude of their effect. We also analyzed the effect of postoperative atrial fibrillation on cardiac surgical complications. Materials and Methods: We retrospectively evaluated 756 patients undergone coronary bypass surgery between June 2010 and September 2017 in our clinic. The cases with and without atrial fibrillation were evaluated in terms of postoperative complications, length of hospitalization and mortality rates. The first endpoint in the study was the detection of atrial fibrillation while the second was the discharge time. Results: In the study, metabolic syndrome, diabetes mellitus, hypertension, and obesity between the ages of 56-78 were found to affect the development of postoperative atrial fibrillation 2.46, 2.3, 1.6, and 1.65 times, respectively. In cases with postoperative atrial fibrillation, infection and stroke were 1.45 and 8.85 times more frequent, respectively. Patients with metabolic syndrome were found to have 31% more prolonged hospitalization, 17% more frequent infection, and 39.1% more frequent hypertension. Obese cases had 23.5% more prolonged stay. Conclusion: In the study, obesity was found to be an independent risk factor for postoperative atrial fibrillation. Patients with metabolic syndrome and obesity who developed postoperative atrial fibrillation had a higher rate of stroke and a longer period of hospitalization. If the causes and mechanisms of postoperative atrial fibrillation are identified in planned cardiovascular interventions, we believe that the cost of hospitalization and morbidity reduces.

Keywords

Metabolic syndrome, obesity, atrial fibrillation, coronary bypass grafting, postoperative evaluations

References

• 1. Ford ES, Giles WH, Mokdad AH. Increasing prevalence of the metabolic syndrome among us. Adults. Diabetes Care 2004Oct;27(10):2444-2449
• 2. Kozan O, Oguz A, Abaci A, Erol C, Ongen Z, Temizhan A, Celik S. Prevalence of the metabolic syndrome among Turkish adults. Eur J Clin Nutr. 2007 Apr;61(4):548-53
• 3. Jidéus L, Blomström P, Nilsson L, Stridsberg M, Hansell P, Blomström-Lundqvist C.. Tachyarrhythmias and triggering factors for atrial fibrillation after coronary artery bypass operations. AnnThoracSurg.2000 Apr;69(4):1064-9
• 4. Barrett TW, Storrow AB, Jenkins CA, Harrell FE Jr, Miller KF, Moser KM, Russ S, Roden DM, Darbar D. Atrial fibrillation and flutter outcomes and risk determination (AFFORD): design and rationale. J Cardiol. 2011 Sep;58(2):124-30
• 5. Delaney JA, Yin X, Fontes JD, Wallace ER, Skinner A4, Wang N, Hammill BG4, Benjamin EJ, Curtis LH, Heckbert SR. Hospital and clinical care costs associated with atrial fibrillation for Medicare beneficiaries in the Cardiovascular Health Study and the Framingham Heart Study. SAGE Open Med. 2018:20;6:205-213
• 6. Watanabe H, Tanabe N, Watanabe T, Darbar D, Roden DM, Sasaki S, Aizawa Y. Metabolic syndrome and risk of development of atrial fibrillation: the Niigata preventive medicine study Circulation.2008Mar11;117(10):1255-60
• 7. Arslan M, Atmaca A, Ayvaz A, Başkal N, Beyhan Z, Bolu E, Can S, Çorakçı A, Dağdelen S, Demirağ NG, Demirer AN, Erbaş T, Gürsoy A, Güllü S, Ilgın ŞD, Karakoç A, Kulaksızoğlu M, Şahin M, Tanacı N, Törüner F, Tütüncü NB, Üçkaya G, Yetkin İ, Yılmaz M. Metabolic Syndrome Guide Türkiye Endocrinology and Metabolism Association. Oct.- 2009: (first edition) p:8 Tuna Printing Industry and Trade Inc. Ankara/Turkey
• 8. Ferreira AF, A Saraiva F, Moreira R, J Cerqueira R, J Amorim M, Pinho P, P Lourenço A, F Leite-Moreira A Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting Surgery. Rev Port Cir Cardiothorac Vasc. 2017;24(3-4):129
• 9. Cochrane AD, Siddins M, Rosenfeldt FL, Salamonsen R, McConaghy L, Marasco S, Davis BB. A comparison of amiodarone and digoxin for treatment of supraventricular arrhythmias after cardiac surgery. Eur J Cardiothorac Surg. 1994;8(4):194-8
• 10. Mathew JP, Parks R, Savino JS, Friedman AS, Koch C, Mangano DT, Browner WS. Atrial fibrillation following coronary artery bypass graft surgery: predictors, outcomes, and resource utilization. Multicenter Study of Perioperative Ischemia Research Group. JAMA 1996 Jul 24-31;276(4):300-6
• 11. Roffman JA, Fieldman A. Digoxin and propranolol in the prophylaxis of supraventricular tachydysrhythmias after coronary artery bypass surgery. Ann Thorac Surg. 1981 Jun;31(6):496-501
• 12. Bannister CF, Finlayson DC, The Endocrine System: Effects of Cardiopulmonary Bypass. In: Mora CT, Guyton R.A., Finlayson DC, Rigatti RL (eds) Cardiopulmonary Bypass 1995:pp180-195. Springer, New York, NY Online ISBN: 978-1-4612-2484-6
• 13. Satman I, Yilmaz T, Sengül A, Salman S, Salman F, Uygur S, Bastar I, Tütüncü Y, Sargin M, Dinççag N, Karsidag K, Kalaça S, Ozcan C, King H. Population-based study of diabetes and risk characteristics in Turkey: results of the Turkish diabetes epidemiology study (TURDEP). Diabetes Care. 2002 Sep;25(9):1551-6
• 14.Ducceschi V, D'Andrea A, Liccardo B, Alfieri A, Sarubbi B, De Feo M, Santangelo L, Cotrufo M. Perioperative clinical predictors of atrial fibrillation occurrence following coronary artery surgery. Eur J Cardiothorac Surg. 1999;16 (4):435-9.
• 15.Ucar HI, Tok M, Atalar E, Dogan OF, Oc M, Farsak B, Guvener M, Yilmaz M, Dogan R, Demircin M, Pasaoglu I. Predictive significance of plasma levels of interleukin-6 and high-sensitivity C-reactive protein in atrial fibrillation after coronary artery bypass surgery. Heart Surg Forum. 2007;10(2):131-5
• 16.Aizawa K, Shoemaker JK, Overend TJ, Petrella RJ, Metabolic syndrome, endothelial function and lifestyle modification. Diab Vasc Dis Res. 2009Jul;6(3):181-9
• 17.Wanahita N, Messerli FH, Bangalore S, Gami AS, Somers VK, Steinberg JS. Atrial fibrillation and obesity-results of a meta-analysis. Am Heart J. 2008 Feb;155(2):310-5
• 18. Berberoğlu Z, Demirağ G. Metabolic Syndrome: Endothelial Dysfunction, Subclinical Inflammation and Hypercoagulability Turkiye Klinikleri J Int Med Sci 2006; 2(3):60-70
• 19.Almassi GH, Schowalter T, Nicolosi AC, Aggarwal A, Moritz TE, Henderson WG, Tarazi R, Shroyer AL, Sethi GK, Grover FL, Hammermeister KE. Atrial fibrillation after cardiac surgery: a major morbid event? Ann Surg. 1997 Oct;226(4):501-11
• 20. Nazeri A, Razavi M, Elayda MA, Lee VV, Massumi A, Wilson JM. Race/ethnicity and the incidence of new-onset atrial fibrillation after isolated coronary artery bypass surgery. Heart Rhythm. 2010 Oct;7(10):1458-63
• 21. Flegel KM, Shipley MJ, Rose G. Risk of stroke in nonrheumatic Atrial fibrillation. Lancet. 1987 Mar 7;1 (8532):526-9
• 22. Kotfis K, Szylińska A, Listewnik M, Strzelbicka M, Brykczyński M, Rotter I, Żukowski M. Early delirium after cardiac surgery: an analysis of incidence and risk factors in elderly (≥65 years) and very elderly (≥80 years) patients, Clin Interv Aging. 2018 May 30;13:1061-1070
• 23. Liu S1, Li Z, Liu Z, Hu Z, Zheng G. Blood transfusion and risk of atrial fibrillation after coronary artery bypass graft surgery: A meta-analysis of cohort studies Medicine (Baltimore). 2018 Mar;97(10):e9700
• 24. Bell DSH, O'Keefe JH. Metabolic syndrome and postoperative atrial fibrillation (POAF) Eur Heart J. 2009; 30(10): 1167–1168
• 25. Patti G, Chello M, Candura D, Pasceri V, D'Ambrosio A, Covino E, Di Sciascio G. Randomized trial of atorvastatin for reduction of postoperative atrial fibrillation in patients undergoing cardiac surgery: results of the ARMYDA-3 (Atorvastatin for Reduction of Myocardial Dysrhythmia After cardiac surgery) study. Circulation. 2006 Oct 3;114 (14):1455-61
• 26. European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery, Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, Van Gelder IC, Al-Attar N, Hindricks G, Prendergast B, Heidbuchel H, Alfieri O, Angelini A, Atar D, Colonna P, De Caterina R, De Sutter J, Goette A, Gorenek B, Heldal M, Hohloser SH, Kolh P, Le Heuzey JY, Ponikowski P, Rutten FH. Guidelines for the management of atrial fibrillation The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J. 2010Oct;31(19):2369-429