Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting—Clinical, Demographic, and Intraoperative Predictors: A Multicenter Observational Study

Background: Postoperative arrhythmias, especially atrial fibrillation (AF), are common complications of coronary artery bypass grafting (CABG) associated with prolonged hospitalization and adverse outcomes. This study aimed to assess the incidence of postoperative AF and identify demographic, clinical, and intraoperative predictors in CABG patients in Cyprus. Methods: This prospective, multicenter observational study was conducted in three cardiac surgery centers in Cyprus between September 2022 and April 2023. Adult elective CABG patients in preoperative sinus rhythm were included; emergency cases and those with prior arrhythmias or conduction disturbances were excluded. Data on demographic, clinical, intraoperative, and postoperative variables, including norepinephrine infusion duration, were collected daily. Postoperative arrhythmias were systematically recorded during hospitalization. Statistical analyses included descriptive statistics, bivariate tests, and multivariable logistic regression to identify independent predictors of postoperative atrial fibrillation. Results: Among 102 patients (mean age 66.8 years, 78.4% male), postoperative arrhythmias occurred in 26.5%. AF was most frequent (20.6%), followed by ventricular tachycardia (2.9%), atrial tachycardia (1.0%), atrioventricular block (1.0%), and one fatal asystole. Key independent predictors of AF were increasing age, atrial enlargement, severely reduced left ventricular ejection fraction (<30%), and prolonged norepinephrine infusion. Conclusions: Postoperative AF remains a prevalent and clinically significant complication after CABG. The association with norepinephrine duration underscores the importance of careful hemodynamic management. Further studies and AI-based prediction models may enhance individualized prevention strategies.