Publication
Predictors of atrial fibrillation post coronary artery bypass graft surgery: new scoring system
Publisher:
BMJ
Date:
06-2023
DOI:
10.1136/OPENHRT-2023-002284
Abstract: Atrial fibrillation (AF) following coronary artery bypass graft surgery (CABG) is common and results in significant increases in hospital stay and financial encumbrance. Determine and use the predictors of postoperative AF (POAF) following CABG to develop a new predictive screening tool. A retrospective case–control study evaluated 388 patients (98 developed POAF and 290 remained in sinus rhythm) who undertook CABG surgery at Townsville University Hospital between 2016 and 2017. The demographic profile, risk factors for AF including hypertension, age≥75 years, transient ischaemic attack or stroke, chronic obstructive pulmonary disease (HATCH) score, electrocardiography features and perioperative factors were determined. Patients who developed POAF were significantly older. On univariate analysis HATCH score, aortic regurgitation, increased p-wave duration and litude in lead II and terminal p-wave litude in lead V1 were associated with POAF as were increased cardiopulmonary bypass time (103.5±33.9 vs 90.6±26.4 min, p=0.001) and increased cross cl time. On multivariate analysis age (p=0.038), p-wave duration ≥100 ms (p=0.005), HATCH score (p=0.049) and CBP Time ≥100 min (p=0.001) were associated with POAF. Receiver operating characteristic curve demonstrated that with a cut-off of ≥2 for HATCH score, POAF could be predicted with a sensitivity of 72.8% and a specificity of 34.7%. Adding p-wave duration in lead II ms and cardiopulmonary bypass time min to the HATCH score increased the sensitivity to 83.7% with a specificity of 33.1%. This was termed the HATCH-PC score. Patients with HATCH scores ≥2, and those with p-wave duration ms, or cardiopulmonary bypass time min were at greater risk of developing POAF following CABG.