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REPERCUSSIONS OF ATRIAL FIBRILLATION IN CARDIAC SURGERY

Joao Vitor Lobo Nascimento, Liscia Divana Carvalho Silva*, Leticia de Paula Carvalho Silva, Paulo Eduardo Sousa Silva, Joaquim Henrique de Carvalho Lobato Filho, Joseildes Castelo Branco Souza, Silvana do Socorro Santos de Oliveira, Ione Rocha Neves, Sandra Regina Alves Freitas, Josilma Silva Nogueira, Fernanda Liene Cavalcante da Cruz, Elaine Cristina Silva Miranda, Roseane Mafra Azevedo, Deylson Silva de Oliveira, Katiana Patricia Marques Ramada, Shirley Santos Martins

Introduction: Atrial fibrillation is a well-tolerated complication in most individuals, being a temporary problem associated with cardiac surgery. However, it can be life threatening in elderly patients and/or patients with left ventricular dysfunction.

Materials and methods: This is a retrospective cross-sectional study with the objective of investigating the repercussions of atrial fibrillation in patients during the postoperative period of cardiac surgery at a hospital in Maranhão, Brazil. The sample was composed of 29 medical records of adult patients undergoing valve replacement and/or myocardial revascularization who developed atrial fibrillation in the postoperative period between the years 2016 to 2017.

Results and discussion: The project was sent to the Research Ethics Committee of the university hospital that hosted the study, and was granted the favourable Opinion nº 2855350. Atrial fibrillation had an incidence of 13.3%. Valve replacement surgery (62.1%) was the most prevalent. In myocardial revascularization (34.5%) the prevalent duration was of 3 to 4 hours (41.4%), with extracorporeal circulation (96.6%) lasting 81 to 120 minutes (62.1%). The prevalent length of hospital stay was more than 40 days (27.6%), and the length of stay in the Cardiac ICU, 6 to 14 days (44.9%). Hemodynamic instability (34.5%) and increased bleeding (17.2%) were the main complications. Beta-blockers (27, 93.1%), heparin/enoxaparin (26, 89.7%) and vasoactive drugs (20, 69%) were the most used. More than half of the patients had atrial valve fibrillation (65.5%), in the mediate postoperative period (65.5%), of paroxysmal type (72.5%), with rapid ventricular response (79.3%), and 2 or 3 episodes (55.2%). All episodes of atrial fibrillation developed within the first seven days of hospitalization.

Conclusion: The prevalent treatment was drug therapy with amiodarone (86.2%) and beta-blockers (93.1). Electrical cardioversion (17.2%) and electrical defibrillation (10.3%) were also used, with low incidence (13.3%). The repercussions of atrial fibrillation were longer hospital stay, increased number of complications and prolonged drug therapy.