Preoperative Diastolic Dysfunction and Perioperative Risk Factors as Predictors of New Onset Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Retrospective Cohort Study.

INTRODUCTION

Despite advancements in technique and the increasing number of coronary artery bypass grafting (CABG) procedures, new-onset postoperative atrial fibrillation (POAF) is one of the most common complications following CABG and remains a major concern. The exact mechanism is unclear, but impaired diastolic function may predispose patients to POAF. Thus, this study aims to evaluate preoperative diastolic dysfunction (DD) and associated factors as predictors of new-onset POAF.

METHODS

This retrospective cohort study involved patients undergoing CABG surgery who met the inclusion criteria between January 2018 to August 2022. DD was measured through preoperative transthoracic echocardiogram, while new-onset POAF was assessed through continuous electrocardiogram.

RESULTS

A total of 191 patients who met the inclusion criteria were enrolled in this study. Data-analysis revealed no significant difference in DD between patients with and without POAF (P = 0.72). Multivariate analysis demonstrated left main coronary artery disease (LMCAD) (odds ratio [OR] = 2.51; 95% confidence interval [CI] [1.12 - 5.59]; P = 0.02), in-stent restenosis (ISR) ≥ 70% (OR = 6.34; 95% CI [1.68 - 23.92]; P < 0.01), reduced ejection fraction ≤ 50% (OR = 2.18; 95% CI [0.94 - 5.06]; P = 0.07), and electrolyte imbalance (OR = 2.14; 95% CI [2.91 - 24.75]; P < 0.01) as the independent predictors of new-onset POAF.

CONCLUSION

DD was not identified as a predictor of new-onset POAF in patients undergoing CABG. The independent predictors identified in this study included male sex, comorbid LMCAD and ISR ≥ 70%, reduced left ventricular ejection fraction ≤ 50%, and postoperative electrolyte imbalance.