Preoperative Left Atrial Parameters as Predictive Factors for Post-Coronary Artery Bypass Grafting Atrial Fibrillation

Ashraf  Mostafa; Amr  Bastawisy; Mahmoud El Nagar; Ihab  Elsharkawy

Ashraf Mostafa Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
Amr Bastawisy Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
Mahmoud El Nagar Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
Ihab Elsharkawy Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt

Keywords: Atrial Fibrillation, Coronary Artery Bypass, Left Atrium

Abstract

Background: Atrial fibrillation (AF) is the most common arrhythmia following coronary artery bypass grafting (CABG), affecting 10% to 40% of patients. Multiple patient-specific and anatomical factors are associated with AF, among which left atrial (LA) size is a key predictor. This study aimed to derive a simple clinical index to identify patients at high risk for AF using available preoperative predictors, including the left atrial volume index (LAVI).

Methods: This prospective observational cohort study enrolled 140 adult patients of both sexes with preoperative sinus rhythm undergoing isolated CABG. Patients were categorized into two groups: an AF group (n=9) and a non-AF group (n=131).

Results: Patients who developed postoperative AF had a significantly higher risk of mortality (p = 0.049), cardiovascular complications (p = 0.034), and congestive heart failure (p = 0.043). However, no significant differences were observed in surgical site infection (p = 0.97) or renal failure (p = 0.56). AF was not a direct cause of death but served as a predictor of increased mortality and other complications. There were no differences in left atrial diameter (3.9 vs. 4.2 cm, p= 0.054) or LAVI (31 vs. 31.6 ml/m3, p= 0.635) between patients with and without postoperative AF, respectively.

Conclusion: Left atrial diameter and LAVI were not found to be significant independent predictors of postoperative AF. However, the development of AF was strongly associated with increased risks of mortality, cardiovascular complications, and congestive heart failure. These findings underscore that postoperative AF, while not a direct cause of death, is a critical marker of adverse outcomes following CABG