Atrial Fibrillation After Elective Isolated Coronary Artery Bypass Graft Surgery (2024)

Dear Editor,

We have read the article by Apaydin et al.^[1] entitled “Could We Predict POAF With a Simple AmbulatoryOscillometry Evaluating Aortic Stiffness?” with great interest. First of all, wecongratulate the authors for their valuable contribution to the literature. However, wewould like to discuss some points about postoperative atrial fibrillation (PoAF) and itsrisk factors.

In that prospective study, the authors investigated the effect of aortic stiffness (AS)status on PoAF in patients who underwent isolated coronary artery bypassgrafting^[1]. AS is an importantsign of aging and atherosclerosis. It is known that this condition is correlated withhypertension (HT), end-stage renal disease, diabetes mellitus, and being over 70 yearsof age^[2]. In the study, pulse wavevelocity (PWV) value was found to be significantly correlated with the development ofPoAF (odds ratio: 1.561; 95% confidence interval: 1.119-2.177). However, the frequencyof HT was found to be quite similar in patients with and without PoAF (47.4%vs. 50%). While PoAF and PWV were significantly correlated in thesegroups, why do the authors think the frequency of HT was similar between the groups? HTis an important risk factor for PoAF and has taken its place in important atrialfibrillation risk assessment scores^[3,4]. In addition, data on the prevalence ofcoronary artery disease in the study were given as “graft count”. The SYNTAX score I isan important indicator of the severity of coronary artery disease and its relationshipwith PoAF is known^[5]. Were the SYNTAXscore I values similar in that patient group?

PoAF is affected by many other factors perioperatively. These include the use of bloodproducts, positive inotropic agents, and especially early medical treatments^[6,7]. How was the postoperative medical treatment of the patients in thestudy group performed? Did all patients start on early metoplorol and statin therapy? Webelieve that clarification of these points will increase the value of the study.

Finally, we would like to emphasize the importance of electrocardiography (ECG) follow-upin the diagnosis of PoAF in the postoperative period. The most important problem inretrospective PoAF studies is that the diagnosis was missed in some patients who did notshow clinical complaints and developed PoAF^[5,8]. However, the study wasplanned prospectively. What kind of problems precluded the authors from performingpostoperative ECG monitoring with continuous telemetry in the clinic? We think that thisis an important limiting point. Perhaps this problem will be overcome in the future withthe developing technology and the use of smartwatches becoming widespread insociety^[9].

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