CAREER: Post Coronary Bypass Atrial Arrhythmia Prediction Rule

DESCRIPTION (provided by applicant):The proposed study seeks to develop and validate a clinical prediction rulefor post-coronary artery bypass grafting (CABG) atrial fibrillation and atrialflutter (AF). These arrhythmias occur in 20-40% of the 500,000 patientsundergoing CABG, and increase the morbidity, cost, and length of stayassociated with the procedure. Though several studies have suggested thatprophylactic therapy with beta-adrenergic blockers decreases the risk ofpost-CABG AF, this efficacy has not been universally appreciated. As aresult, several new prophylactic therapies have been introduced, though somewith significant toxicities associated with them. It is therefore imperativeto identify a priori those individuals most at risk of developing post-CABGAF, as well as those unlikely to develop this endpoint. In this manner, thoseindividuals most at risk of developing post-CABG AF may be targeted forprophylactic therapy, while those in a low risk category may be spared theexposure to a potentially deleterious therapy from which they are less likelyto derive benefit. Additionally, the identification of a high-risk subgroupwould allow for the execution of smaller randomized controlled trials, and mayprovide insight into the etiology of post-CABG AF.The study is a retrospective cohort study designed to identify pre-, intra-,and post-operative variables which may be associated with post-CABG AF. Fromthese results, a clinical prediction rule will be formulated. Validation ofthe prediction rule will then take place in a prospective cohort study using adifferent group of patients from which the rule was derived. This will allowfor the assessment of both validity and generalizability.The candidate has committed himself to a career as an independentinvestigator, with an interest in the application of rigorous epidemiologictechniques to questions of importance in cardiac electrophysiology, hisarea of clinical expertise. This project will be an integral part of thecandid