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Postoperative Atrial Fibrillation After Elective Coronary Artery Bypass Grafting Surgery in Patients with Sleep-Disordered Breathing
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A2426 - Postoperative Atrial Fibrillation After Elective Coronary Artery Bypass Grafting Surgery in Patients with Sleep-Disordered Breathing
Author Block: M. Tafelmeier1, M. Schmidt1, M. Knapp1, S. Bauer1, B. Floerchinger2, D. Camboni2, Y. Zausig3, S. Wittmann3, C. Schmid2, L. S. Maier1, S. Wagner1, M. Arzt1; 1Department of Internal Medicine II (Cardiology, Pneumology, and Intensive Care), University Medical Center Regensburg, Regensburg, Germany, 2Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany, 3Department of Anaesthesia, University Medical Center Regensburg, Regensburg, Germany.
Rationale: New onset postoperative atrial fibrillation (POAF) ranks among the most common complications after cardiac surgery and is linked to increased morbidity, mortality, and prolonged postoperative length of stay. Epidemiological and clinical studies have suggested a strong association between obstructive sleep apnea (OSA) and atrial fibrillation. However, the association between OSA and POAF in cardiac surgery patients has scarcely been examined to date. This study evaluated the incidence of POAF after elective coronary bypass grafting surgery in patients with and without OSA.
Methods: The presence and severity of OSA had been assessed with polygraphic recordings in 36 patients with sinus rhythm before they underwent elective coronary bypass grafting surgery. OSA was diagnosed if ≥50% of all apneas were found to be obstructive. Mild OSA was defined as an apnea-hypopnea-index (AHI) ≥5-15/h, while moderate to severe OSA was defined as an AHI ≥15/h. New onset of POAF was consistently monitored within a subpopulation of the CONSIDER-AF study cohort (ClinicalTrials.gov Identifier NCT: 02877745) during the first seven postoperative days using cardiac event recorders (Braemar ER920AF, USA). Four patients with central sleep apnea were excluded from this analysis.
Results: 34% of all patients were diagnosed with mild OSA. Moderate to severe OSA was present in 53% of all patients. The incidence of POAF was 56%, although only 9% of all patients had a history of atrial fibrillation (6% paroxysmal atrial fibrillation, 3% persistent atrial fibrillation). The severity of OSA was significantly associated with POAF (no vs. mild vs. moderate to severe OSA: 0% vs. 55% vs. 71%, p = 0.027). The association between the severity of OSA and POAF remained significant after adjusting for age and impaired left ventricular systolic function (p = 0.040).
Conclusions: 53% of all patients with elective coronary bypass grafting surgery were affected by POAF. OSA is associated with POAF independently of age and impaired left ventricular systolic function. Further large-scale prospective studies are needed to identify specific risk populations for POAF in cardiac surgery and to optimize their postoperative outcome.
Author Block: M. Tafelmeier1, M. Schmidt1, M. Knapp1, S. Bauer1, B. Floerchinger2, D. Camboni2, Y. Zausig3, S. Wittmann3, C. Schmid2, L. S. Maier1, S. Wagner1, M. Arzt1; 1Department of Internal Medicine II (Cardiology, Pneumology, and Intensive Care), University Medical Center Regensburg, Regensburg, Germany, 2Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany, 3Department of Anaesthesia, University Medical Center Regensburg, Regensburg, Germany.
Rationale: New onset postoperative atrial fibrillation (POAF) ranks among the most common complications after cardiac surgery and is linked to increased morbidity, mortality, and prolonged postoperative length of stay. Epidemiological and clinical studies have suggested a strong association between obstructive sleep apnea (OSA) and atrial fibrillation. However, the association between OSA and POAF in cardiac surgery patients has scarcely been examined to date. This study evaluated the incidence of POAF after elective coronary bypass grafting surgery in patients with and without OSA.
Methods: The presence and severity of OSA had been assessed with polygraphic recordings in 36 patients with sinus rhythm before they underwent elective coronary bypass grafting surgery. OSA was diagnosed if ≥50% of all apneas were found to be obstructive. Mild OSA was defined as an apnea-hypopnea-index (AHI) ≥5-15/h, while moderate to severe OSA was defined as an AHI ≥15/h. New onset of POAF was consistently monitored within a subpopulation of the CONSIDER-AF study cohort (ClinicalTrials.gov Identifier NCT: 02877745) during the first seven postoperative days using cardiac event recorders (Braemar ER920AF, USA). Four patients with central sleep apnea were excluded from this analysis.
Results: 34% of all patients were diagnosed with mild OSA. Moderate to severe OSA was present in 53% of all patients. The incidence of POAF was 56%, although only 9% of all patients had a history of atrial fibrillation (6% paroxysmal atrial fibrillation, 3% persistent atrial fibrillation). The severity of OSA was significantly associated with POAF (no vs. mild vs. moderate to severe OSA: 0% vs. 55% vs. 71%, p = 0.027). The association between the severity of OSA and POAF remained significant after adjusting for age and impaired left ventricular systolic function (p = 0.040).
Conclusions: 53% of all patients with elective coronary bypass grafting surgery were affected by POAF. OSA is associated with POAF independently of age and impaired left ventricular systolic function. Further large-scale prospective studies are needed to identify specific risk populations for POAF in cardiac surgery and to optimize their postoperative outcome.
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