Atrial fibrillation in cardiothoracic critically ill patients
CCCF ePoster library. Babu A. 10/02/17; 198147; 108
Aswin Babu
Aswin Babu
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Atrial fibrillation in cardiothoracic critically ill patients

Zochios Vasileios​1​; Babu Aswin​1; Singh Joht​1; Singh Harjot1

University Hospitals Birmingham NHS Foundation Trust

Department of Critical Care Medicine, Queen Elizabeth Hospital, Edgbaston, Birmingham, B15 2WB, UK

Perioperative Critical Care and Trauma Trials Group, Institute of Inflammation and Ageing

Centre of Translational Inflammation Research

University of Birmingham, Birmingham, UK

Introduction: Acute onset atrial fibrillation (AF) after cardiac surgery is a common dysrhythmia which causes significant morbidity and prolonged intensive care and hospital length of stay (LOS) [1].

Methods: After approval by the local Clinical Risk and Compliance unit was obtained, we retrospectively identified patients who underwent cardiothoracic surgery between January 2017 to March 2017. Adult patients undergoing coronary artery bypass grafting (CABG), valve surgery or a combination of graft and valve surgery were included. Those with pre-existing AF; heart or lung transplant recipients and patients requiring mechanical circulatory support were excluded. A total of 138 patients were included. Data collected from a retrospective review of the electronic chart system of these patients was analysed. Variables reviewed included: electrolytes and electrolyte replacement, requirement of cardiovascular support, PaO2:FiO2 ratio, whether AF prophylaxis (beta-blockers, calcium channel blockers, amiodarone) was given in accordance with NICE guidelines and their relationship with the onset of AF. Multivariate logistic regression with age and gender adjusted for, was used to assess the association between variables.

Results: Out of 138 patients, 108 (79%) were male and 30 (21%) were female. The mean age of the cohort was 65 years of age. Fifty (36%) patients developed post-operative AF. This correlated with an increased mean hospital LOS post-op compared to patients without AF, with mean LOS being twelve (7.4) and eight (4.6) days respectively (P < 0.001).  Eighty-three (62%) patients received AF prophylaxis before surgery. Out of the 83 patients, 82 (95%) were already on anti-AF medications (beta-blockers, Calcium channel blockers and amiodarone) as part of their regular medication regimen. However, receiving AF prophylaxis was not associated with a reduction in the incidence of post-operative AF (P < 0.32). Hypokalemia (K < 4.0 mEq/L) was associated with a higher risk of developing post-operative new onset AF but this was not statistically significant (OR 1.52, P< 0.53, CI (0.4-5.7)). Perioperative acidemia (pH<7.35) was also linked with a higher risk of post-operative new onset AF but this was not significant statistically (OR 1.15, P < 0.86, CI (0.2 - 5.3)). Our analysis also illustrates that mild/ moderate hypoxemia (Berlin Criteria) [2] is associated with a greater chance of developing postoperative new onset AF (OR 3.99, P < 0.00.1, CI (1.8 - 8.7)). Out of 60 patients with mild/moderate hypoxemia, 31 went on to develop postoperative AF. The mean PaO2:FiO2 ratio in the mild/moderate hypoxemia group was 32 (5.1).

Conclusion: Our service evaluation shows a statistically significant relationship between hypoxemia and the onset of AF after cardiac surgery. This warrants further investigation and future studies to look more closely at the oxygenation targets for cardiac surgical patients. We also observed a prolonged LOS in post-op AF cohort of patients. Therefore, treating the AF efficiently and effectively in accordance with national evidence-based guidelines would likely be cost-effective in the long term. We were unable to correlate the timing of AF onset as it is poorly documented on the electronic chart system, therefore unable to assess compliance with local and national guidelines.

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