Parkview Heart Institute (PHI) Postoperative Atrial Fibrillation (POAF) in Coronary Artery Bypass (CABG) and Aortic Valve Replacement (AVR) Surgery: A Chart Review
Abstract
Background: Post-operative Atrial fibrillation (POAF) is a common complication associated with cardiac operations, and it occurs due to a lack of coordination of atrial depolarization, so the AV node fires as soon as its refractory period ends. Major consequences include clot formation, stroke, and other post-operative complications. The prevalence rate of POAF is 30 to 40%, while a combined CABG and AVR procedure is as high as 60%. Patient specific factors like medical history can also indicate predictors for POAF, but age has been the most widely accepted predictor. Objective: Postoperative atrial fibrillation has proven to be a prevalent complication in CABG and AVR procedures. The objectives of the current study is to analyze the prevalence of POAF, examine predictive risk factors for POAF, and analyze the treatment and management of POAF, and how it affects patient outcomes. Methods & Design: This study was a retrospective electronic medical record chart review (EPIC) of 169 patients from June 2014, to January 2015. This project was part of a larger study that analyzed 83 data collection points per a patient and specifically analyzed the prevalence of POAF, and the comparison of POAF and none POAF for patient demographics, BMI, pre-operative medications, procedures, patient history, and complications. A two-tailed Z-test was used to analyze significance. Results: The prevalence of POAF was 36.09%, and the combined CABG and AVR procedure had an incidence of 35%. Preoperative medications did not show any significance (p >0.05) to preventing POAF. A history of atrial fibrillation, other arrhythmias, or a myocardial infarction showed to be significant (p< 0.05) predictors for POAF. Also age was a significant indicator of POAF. Conclusion: This study found that the prevalence of POAF is in agreement with the national average but the combined CABG and AVR procedure has a much lower incidence rate than what is indicated in the literature. It is also in agreement that age and a history of atrial fibrillation, other arrhythmias, and myocardial infarction are indicators of POAF. Pre-operative medications do not help prevent POAF but are known to prevent other post-operative complications.