Incidence of Atrial Fibrillation after Off-pump and On-pump Coronary Artery Surgery: Current Best Available Evidence

Coronary artery bypass graft (CABG) surgery is an effective form of treatment for patients with ischemic heart disease. This method is well tolerated by majority of patients; however it can cause some complications. The early postoperative atrial fibrillation (AF) is among the most common ones. Incidence of postoperative AF varies from 5 to over 40% according to definition of the arrhythmia, patients' characteristics, type of operation and method of heart rhythm monitoring. Some investigators consider postoperative AF to be a benign and self-limited arrhythmia. It rarely has a fatal outcome, however may lead to instability of the patient, prolongs hospital stay and increases costs. In some cases AF can be the reason of perioperative myocardial infarction, stroke, and persistent congestive heart failure. The use of cardiopulmonary bypass (CPB), the influence of cardioplegia and myocardial ischemia are possible factors responsible for postoperative occurrence of AF. For last few years off-pump coronary artery bypass (OPCAB) surgery on the beating heart, without cardiopulmonary bypass has become very popular. Rapid development of technology for OPCAB, especially stabilizing devices, has made it possible to approach almost all surfaces of the beating heart. OPCAB has excellent short-term results, however is not completely free from complications. The problem of atrial fibrillation in patients after beating heart surgery appears to be controversial. This review article analyses the available evidence to try and solve this controversy.