Online ISSN: 2515-8260

Author : Ahmed, Ahmed Mahfouz

Current Approaches for the Prediction of Atrial Fibrillation Development and Progression

Mahmoud Hassan Shah; Hisham Samir Roshdy; Mohammad Safwat Abd Eldayem; Ahmed Mahfouz Ahmed

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 3, Pages 2116-2139

Atrial fibrillation (AF) is the most common arrhythmia inclinical practice. Several
conventional and novel predictorsof AF development and progression (from paroxysmalto
persistent and permanent types) have been reported.The most important predictor of AF
progression ispossibly the arrhythmia itself. The electrical, mechanicaland structural
remodeling determines the perpetuationof AF and the progression from paroxysmal to
persistentand permanent forms. Common clinical scores such asthe hypertension, age ≥ 75
years, transient ischemicattack or stroke, chronic obstructive pulmonary disease,and heart
failure and the congestive heart failure,hypertension, age ≥ 75 years, diabetes mellitus,
stroke/transient ischemic attack, vascular disease, age 65-74years, sex category scores as well
as biomarkers relatedto inflammation may also add important information onthis topic. There
is now increasing evidence that even inpatients with so-called lone or idiopathic AF, the
arrhythmiais the manifestation of a structural atrial disease whichhas recently been defined
and described as fibrotic atrialcardiomyopathy. Fibrosis results from a broad rangeof factors
related to AF inducing pathologies such ascell stretch, neurohumoral activation, and
oxidativestress. The extent of fibrosis as detected either by lategadolinium enhancement -
magnetic resonance imaging
or electroanatomic voltage mapping may guide thetherapeutic approach based on the
arrhythmia substrate.The knowledge of these risk factors may not only delayarrhythmia
progression, but also reduce the arrhythmiaburden in patients with first detected AF. The
presentreview highlights on the conventional and novel risk

Predictors of Atrial Fibrillation after Coronary Artery Bypass Graft Surgery and its Impact on Patient Outcome

Mahmoud Hassan Shah; Hisham Samir Roshdy; Mohammad Safwat Abd Eldayem; Ahmed Mahfouz Ahmed

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 2, Pages 2603-2614

Background: Postoperative atrial fibrillation (POAF) is a common and potentially morbid
complication following cardiac surgery. It was reported to be associated with greater inhospital
mortality; prolonged hospital stays. In addition, the long-term survival was worse in
patients who developed POAF. Patients who develop POAF incur additional hospital
treatment cost and 2-to-4-fold increased risk of major adverse cardiac events.
Objective: To determine the possible predictors of POAF after coronary artery bypass
surgery and its impact on outcome.
Methods: Two hundred patients were enrolled; they were divided into 2 groups; Group I (n =
100 patients) developed POAF and group II (n = 100 patients) did not developed POAF. All
patients were subjected to history, examination, ECG, echocardiography, laboratory
investigation as CBC, coagulation profile, kidney function tests, liver enzymes and high
sensitivity troponin and coronary angiography to assess severity of coronary artery disease by
SYNTAX score.
Results: POAF score which contain 9 variables: Age >60 y, Smoking, COPD, CP bypass time
(min) >86.5, Vent. Time <23.5, PLR >113.4, LVEF <53.5, RV function by TAPSE <2.15 and
Syntax score >34.5. Each variable takes points according to multivariate analysis with total
score 20. ROC curve analysis was done to pick up the best cut off value of POAF Score and
incidence of POAF which revealed POAF Score more than 10 has sensitivity 99 % and
specificity 86% Area under the curve 0.99. Conclusion: POAF after CABG is associated with
higher morbidity and mortality, prolonged recumbence in the hospital. Prediction of POAF
might be useful in detection of patients at risk for these complications using POAF risk