Document Detail


Perioperative atrial arrhythmias in noncardiothoracic patients: a review of risk factors and treatment strategies in the veteran population.
MedLine Citation:
PMID:  21056136     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Perioperative atrial arrhythmias (PAAs) in noncardiothoracic patients have poorly defined risk factors and management.
METHODS: The surgical intensive care unit database was queried for patients who developed PAAs from 2008 to 2009. Demographics, comorbidities, preoperative data (electrocardiography, chest x-rays, laboratory results), medications, intraoperative variables, management, and outcomes of atrial arrhythmias were collected. Controls were randomly chosen in a 3:1 ratio. Comparisons were performed using χ² tests, Student's t tests, or nonparametric comparisons as appropriate. Multivariate logistic regression was performed.
RESULTS: Five hundred sixty-one patients were admitted to the surgical intensive care unit. Three hundred fifty-four (63%) had noncardiothoracic surgery, and 30 (8.5%) developed PAAs. The mean age of patients with PAAs was 66 ± 7.3 years, compared with 64 ± 11 years for controls (P = NS), with most patients undergoing general (60%) and vascular (33%) surgery. PAA patients were more likely to have coronary artery disease (P = .029), cardiomegaly (P = .011), and premature atrial contractions (P = .016) and to take aspirin (P = .010). On multivariate logistic regression, predictors of atrial arrhythmias were premature atrial contractions, preoperative hypokalemia, intraoperative adverse events, and cardiomegaly. Most PAA patients received amiodarone (63%). Ten percent required electrical cardioversion, and 26% received anticoagulation. PAA patients had significantly longer intensive care unit lengths of stay (P = .032).
CONCLUSION: Coronary artery disease, cardiomegaly, hypokalemia, and premature atrial contractions were significantly associated with PAAs in noncardiothoracic patients. Prospective studies are needed to define treatment guidelines.
Authors:
Jennifer Marye Burris; Anuradha Subramanian; Shubhada Sansgiry; Carlos H Palacio; Faisal G Bakaeen; Samir S Awad
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  American journal of surgery     Volume:  200     ISSN:  1879-1883     ISO Abbreviation:  Am. J. Surg.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-08     Completed Date:  2011-01-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370473     Medline TA:  Am J Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  601-5     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 Elsevier Inc. All rights reserved.
Affiliation:
Department of General Surgery, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Amiodarone / therapeutic use
Anti-Arrhythmia Agents / therapeutic use*
Atrial Fibrillation / epidemiology*,  etiology,  therapy
Electric Countershock / methods*
Follow-Up Studies
Hospital Mortality / trends
Hospitals, Veterans
Humans
Incidence
Intensive Care Units
Length of Stay
Middle Aged
Perioperative Period*
Practice Guidelines as Topic*
Prognosis
Retrospective Studies
Risk Factors
Surgical Procedures, Operative / adverse effects*
United States / epidemiology
Veterans*
Chemical
Reg. No./Substance:
0/Anti-Arrhythmia Agents; 1951-25-3/Amiodarone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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