Atrial Fibrillation Following Surgical Management of Ischemic Heart Disease; One Year, Single Center, Single Surgeon Results

Yıl 2012, Cilt: 15 Sayı: 2, 65 - 74, 01.02.2011

Ahmet Barış Durukan Hasan Alper Gürbüz Elif Durukan Murat Tavlaşoğlu Ertekin Utku Ünal Fatih Tanzer Serter Halil Brahim Uçar Cem Organcıoğlu

Öz

Introduction: Postoperative atrial fibrillation is the most common arrhythmia following bypass surgery with significant morbidity, mortality and increased healthcare costs. The aim of this study is to determine the incidence and timing of atrial fibrillation, identify the risk factors covering preoperative and intraoperative periods, evaluate rate of return to sinus rhythm by disharge, and explore the impact on postoperative outcomes in a large group of patients operated in a single center by a single surgeon. Patients and Methods: Between January 2011 and January 2012, 418 patients on preoperative sinus rhythm were operated for ischemic heart disease and associated complications (left ventricle aneurysm repair and ischemic mitral insufficiency) in a single center, by a single surgeon. The preoperative, intraoperative and postoperative variables were studied. Results: The mean age of the patients were 61.92 ± 10.05, and 77.5% were male. Atrial fibrillation developed in 68 (16.3%) patients. The incidence peaked at second day. Patients with atrial fibrillation were older (p< 0.001). Gender, preoperative comorbidities, ejection fraction, left atrial diameter, preoperative beta-blocker use, leukocyte count, type of operation and intraoperative variables did not affect its occurence. Intensive care unit and hospital length of stay were longer (p< 0.05). 95.5% (n= 65) of patients were in normal sinus rhythm at discharge. Conclusion: Postoperative atrial fibrillation is a popular subject with unknowns and controversial results which may lead to wrong interpretations. We believe that every center has its own risk factors related with the population of that region. Discussion will last, but simple precautions and close monitoring will help to minimize adverse outcomes.

Anahtar Kelimeler

Atrial fibrillation; coronary artery disease; risk factors

İskemik Kalp Hastalığı Cerrahi Tedavisi Sonrası Gelişen Atriyal Fibrilasyon; Bir Yıllık, Tek Merkez, Tek Cerrah Sonuçlarımız

Öz

Giriş: Postoperatif atriyal fibrilasyon, koroner baypas sonrası en sık görülen; ciddi morbidite, mortalite ve artmış sağlık harcamalarına neden olan bir ritim bozukluğudur. Bu çalışmanın amacı; tek merkez, tek cerrah tarafından yapılan geniş bir hasta grubunda atriyal fibrilasyon insidansının ve zamanlamasının belirlenmesi, preoperatif ve intraoperatif risk faktörlerinin belirlenmesi, taburculukta sinüs ritmine dönüşün saptanması ve postoperatif sonuçlara etkisinin değerlendirilmesidir. Hastalar ve Yöntem: Ocak 2011-Ocak 2012 tarihleri arasında, preoperatif sinüs ritminde olan 418 hasta iskemik kalp hastalığı ve komplikasyonları için (sol ventrikül anevrizma tamiri, iskemik mitral yetmezliği) tek merkezde, tek cerrah tarafından opere edilmiştir. Preoperatif, intraoperatif ve postoperatif değişkenler çalışılmıştır. Bulgular: Hastaların ortalama yaşı 61.92 ± 10.05 yıldı ve %77.5'i erkekti. Altmış sekiz (%16.3) hastada atriyal fibrilasyon gelişti, ikinci günde pik yaptı. Atriyal fibrilasyon gelişen hastalar daha yaşlı idi (p< 0.001). Cinsiyet, preoperatif komorbiditeler, ejeksiyon fraksiyonu, sol atriyum çapı, preoperatif beta-bloker kullanımı, beyaz küre sayısı, operasyon tipi ve intraoperatif değişkenler atriyal fibrilasyon oluşumunu etkilemedi. Atriyal fibrilasyon gelişen hastalarda yoğun bakım ve hastanede kalış süreleri daha uzundu (p< 0.05). Taburculukta hastaların %95.5 (n= 65)'i sinüs ritminde idi. Sonuç: Postoperatif atriyal fibrilasyon çok bilinmeyenli, çelişkili sonuçlara sahip ve halen popülerliğini koruyan bir konudur, bu sebeple yanlış yorumlara açıktır. Biz her ülkenin ve her merkezin kendine has risk faktörleri olduğunu düşünüyoruz. Bu konu ile ilgili tartışmalar hiç sona ermeyecektir, ancak basit önlemler ve yakın takiple olumsuz sonuçlardan kaçınılabilir

Anahtar Kelimeler

Atriyal fibrilasyon, koroner arter hastalığı, risk faktörleri

Kaynakça

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