Value of Atrial Fibrillation Prophylaxis after Coronary Artery Bypass Graft Surgery

Background: Heart surgery patients who develop acute and new-onset AF (postoperative atrial fibrillation, POAF) are among the most common postoperative complications, affecting around 35 percent of those who undergo the procedure. Objective: To assess the effectiveness of amiodarone in prophylaxis of AF post coronary artery bypass surgery (CABG). Patients and Methods: Our work represents a randomized clinical trial, which was carried out at National Heart Institute and Zagazig University from the period of August 2020 to June 2021. 68 patients, admitted for CABG and had high risk score according to POAF score, were included in our study. Results: Regarding mean left ventricular ejection fraction (LVEF), in group I was 47.52±5.85 while in group II it was 49.85±6.25. There was a statistically non-significant difference between the groups with a P value of 0.414. Mean Intensive Care Unit (ICU) period was 4.42±1.35 in group I, and group II was 2.73±0.95. The difference between the groups was statistically significantly shorter among group II (prophylaxis group) (P <0.01). Regarding development of POAF, in group I, the incidence of POAF was 85.3% while in group II, it was 38.2%. Difference among the two studied groups was statistically significantly lower in the group II (prophylaxis group). Conclusion: A prophylactic amiodarone strategy dramatically decreased incidence of POAF risk. All previous estimations of POAF risk reduction using prophylactic amiodarone were found to be accurate. Amiodarone was more effective in preventing postoperative atrial fibrillation with no serious side effects and it decreased postoperative ICU stay

Predictors of high calcium score in patients with negative myocardial perfusion imaging

Background: Coronary artery disease (CAD) is one of the major cardiovascular diseases. Myocardial perfusion imaging (MPI) using single photon emission computed tomography (SPECT) plays an important role in the diagnosis and prognosis of CAD.Objective: The aim of the present study was to reduce the generalization of doing calcium score for all coronary cardiac patients with negative myocardial perfusion imaging. Patients and methods: A retrospective cohort study analysis using data from Alfa Scan Center, a major outpatient radiology center in Cairo, Egypt, and conducted in Cardiology Department, Faculty of Medicine, Zagazig University that included a total sample of 1168 participants with negative myocardial perfusion imaging not known to have history of CAD, and age ranged between 20 to 80 years from both sexes. All patients were subjected for SPECT-MPI after the intravenous injection of 99mTc-sestamibi.Results: There was statistically significant difference between the two groups regarding age, gender, weight, chest pain, hypertension, dyslipidemia, diabetes, family history of CAD, beta blockers, aspirin, resting diastolic blood pressure (DBP), rest ECG abnormalities and exercise duration. Age, gender, diabetes mellitus and dyslipidemia were the predictors of any coronary artery calcification (CAC > 0) in patients with negative myocardial perfusion imaging. Age, gender and Duke Treadmill Score were the predictors of significant coronary artery calcification (CAC > 100) in patients with negative myocardial perfusion imaging.Conclusion: Calcium score for all not known coronary cardiac patients with negative MPI is a mandatory, particularly if they are old, male gender and have multiple risk factors