Postoperative Atrial Fibrillation after Isolated Coronary Artery Bypass Graft Surgery

단독관상동맥우회로술 후 발생한 심방세동

  • Suh, Jong-Hui (Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea) ;
  • Park, Chan Beom (Department of Thoracic and Cardiovascular Surgery, St. Paul’s Hospital, College of Medicine, The Catholic University of Korea) ;
  • Moon, Mi-Hyoung (Department of Thoracic and Cardiovascular Surgery, St. Paul’s Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kweon, Jong Bum (Department of Thoracic and Cardiovascular Surgery, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Young-Du (Department of Thoracic and Cardiovascular Surgery, Holy Family Hospital, College of Medicine, The Catholic University of Korea) ;
  • Jin, Ung (Department of Thoracic and Cardiovascular Surgery, Kangnam St. Mary’s Hospital, College of Medicine, The Catholic University of Korea) ;
  • Moon, Seok-Whan (Department of Thoracic and Cardiovascular Surgery, St. Paul’s Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Chi-Kyung (Department of Thoracic and Cardiovascular Surgery, St. Paul’s Hospital, College of Medicine, The Catholic University of Korea)
  • 서종희 (가톨릭대학교 의과대학 의정부성모병원 흉부외과) ;
  • 박찬범 (가톨릭대학교 의과대학 성바오로병원 흉부외과) ;
  • 문미형 (가톨릭대학교 의과대학 성바오로병원 흉부외과) ;
  • 권종범 (가톨릭대학교 의과대학 대전성모병원 흉부외과) ;
  • 김영두 (가톨릭대학교 의과대학 부천성가병원 흉부외과) ;
  • 진웅 (가톨릭대학교 의과대학 강남성모병원 흉부외과) ;
  • 문석환 (가톨릭대학교 의과대학 성바오로병원 흉부외과) ;
  • 김치경 (가톨릭대학교 의과대학 성바오로병원 흉부외과)
  • Received : 2008.07.31
  • Accepted : 2008.09.16
  • Published : 2009.02.05

Abstract

Background: Postoperative atrial fibrillation (AF) is a common complication after coronary artery bypass graft (CABG) surgery. Although postoperative AF is regarded as benign, transient and self-limited, it has been associated with increased morbidity, thromboembolic events and an increased duration and cost of hospitalization. Material and Method: From January 1994 to December 2007, 190 patients that had isolated CABG surgery were divided into two groups. Group 1 (n=139) involved those who had postoperative atrial fibrillation, and group 2 (n=51) did not have any such events. We reviewed the medical records retrospectively including the incidence of postoperative AF, patient characteristics, surgery related factors and the outcome of the patients with postoperative AF. Result: The frequency of postoperative AF was 26.8%, the conversion rate to regular sinus rhythm before discharge was 82.4%; 82.4% of the AF developed within the first three postoperative days. Although the postoperative AF group was significantly older and had a prolonged postoperative Intensive care unit (ICU) stay, there was no difference in the aortic crossclamp time or duration of hospitalization. No spontaneous defibrillation at declamping, and longer duration of cardiopulmonary bypass were significantly related to the development of postoperative AF. However, postoperative treatment with a beta blocker was associated with a decreased incidence of postoperative AF. The multivariate analysis showed that age and ICU stay were significantly associated with the development of POAF. Spontaneous defibrillation and postoperative beta blocker treatment were significantly associated with a decreased frequency of POAF. Conclusion: AF after CABG surgery is a common complication associated with increased morbidity and a longer ICU stay. Therefore, various strategies aimed at reducing AF, and its complications, such as postoperative treatment with a beta blocker should be considered.

배경: 심방세동은 관상동맥우회로술후 흔히 발생하는 합병증으로, 대부분 일시적이고 양호한 경과를 보이나, 혈전색전증의 위험성을 증가시키며, 유병률의 증가와 재원기간의 증가로 인하여 의료비용의 증가를 초래할 수 있다. 대상 및 방법: 1994년 1월 1일부터 2007년 12월 31일까지 단독관상동맥우회술을 시행한 190명의 환자 중 수술 후 심방세동이 발생한 군(1군: n=139)과 발생하지 않은 군(2군: n=51)을 나누어 수술 후 심방세동 발생율, 환자의 특성, 수술관련 인자 및 수술 후 심방세동 발생으로 인한 결과를 의무기록을 토대로 후향적으로 분석하였다. 결과: 수술 후 심방세동의 발생율은 26.8%였으며, 퇴원전까지 정상동방결절리듬으로 회복된 경우는 82.4%였고, 심방세동 발생 환자의 82.4%는 수술 후 3일 이내에 발생하였다. 술후 심방세동군에서는 나이가 유의하게 많았으며, 대동맥겸자 차단시간의 차이는 없었으나, 대동맥 겸차차단 해제시 자발적으로 정상 심전도를 회복하지 못한 경우가 많았으며, 체외순환시간이 더 긴 것으로 나타났다. 수술후 베타차단제의 사용이 심방세동의 발생을 감소시키는 것으로 나타났으며, 재원기간의 차이는 없었으나, 중환자실 체류기간은 심방세동군에서 유의하게 길었다. 다변량 분석에서는 연령, 대동맥겸차 해제후 자발적 심박동 회복여부, 중환자실 재원기간 및 술후 베타 차단제의 사용이 유의한 인자로 분석되었다. 결론: 관상동맥우회로술후 심방세동은 매우 흔한 합병증으로 유병률이 증가되며, 중환자실 재원기간의 증가를 초래한다. 따라서, 술후 심방세동의 발생을 예방하기 위한 조치들이 필요할 것으로 생각되며, 특별한 금기사항이 없다면, 술후 베타 차단제를 적극적으로 사용하는 것이 좋을 것으로 생각된다.

Acknowledgement

Supported by : 가톨릭 중앙의료원

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