Nadorak O. Predictors of occurrence and prognosis of postoperative atrial fibrillation in patients with ischemic heart disease.

Dissertation contains solution of the contemporary task of cardiology - using clinical, instrumental and laboratory studies predictors of occurrence and prognosis of postoperative atrial fibrillation (POAF) in patients with ischemic heart disease were identified. It was established that POAF is a most common complication of coronary artery bypass grafting (CABG). The risk of POAF is 33% in patients after isolated CABG and 49.1% after CABG combined with valvular prothesing. The main predictors of POAF are multivessel coronary artery disease, mitral regurgitation of the 2nd and higher degree, aneurysm and reduced (? 45%) ejection fraction of the left ventricle, diabetes mellitus, lack of background preventive usage of beta-blockers, angiotensin-converting enzyme inhibitors and statins. Intraoperative factors that affect the occurrence POAF are the duration of cardiopulmonary bypass and aortic clamping time. Postoperative factors are increase of C-reactive protein more than 5 g/l and leukocytes more than 10*109 U/l, decrease of glomerular filtration rate less than 60 ml/min and hemoglobin less than 100 g/l. Based on evaluation of the course of POAF, approaches for prevention of complications were grounded. Late emergence of POAF after cardiac surgery and duration of the episode more than 11 hours determine the need for use of amiodarone, antithrombotic drugs within 6 months after bypass surgery to prevent recurrence of AF and late postoperative complications.