Cardioplegic arrest does not increase the risk of atrial fibrillation after coronary artery bypass surgery

Terhi K. Hakala

doi:10.1016/j.ejcts.2003.12.016

February 4, 2004European Journal of Cardio-Thoracic Surgery

Cardioplegic arrest does not increase the risk of atrial fibrillation after coronary artery bypass surgery

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Why the study?

Does off-pump CABG reduce postoperative atrial fibrillation compared to on-pump CABG in patients undergoing coronary artery bypass surgery?

Structured PICO

Does off-pump CABG reduce postoperative atrial fibrillation compared to on-pump CABG in patients undergoing coronary artery bypass surgery?

P

Population

228 patients undergoing coronary artery bypass grafting (CABG) between October 1998 and December 2002

I

Intervention

Off-pump CABG (without cardiopulmonary bypass and cardioplegic arrest)

C

Comparator

On-pump CABG (with cardiopulmonary bypass and cardioplegic arrest), individually matched by gender, age (+/-3 years), left ventricle ejection fraction (+/-5%), history of myocardial infarction, unstable angina, and beta-blocker medication

O

Outcome

Occurrence of postoperative atrial fibrillation (AF)hard clinical

Off-pump CABG does not reduce the incidence of postoperative atrial fibrillation compared to on-pump CABG, suggesting cardiopulmonary bypass and cardioplegic arrest are not the primary drivers of this complication.

Implication

Off-pump CABG was not associated with lower postoperative AF; leaves open whether bypass technique influences this outcome.

Abstract

OBJECTIVE: Atrial fibrillation (AF) is the most common arrhythmia after coronary artery bypass grafting (CABG). It is a considerable source of morbidity, prolongs hospital stay and increases costs of treatment. Atrial cannulation, cardiopulmonary bypass and cardioplegic arrest have been suggested to play a role in the development of AF after CABG. The aim of this case-control study was to evaluate the role of cardiopulmonary bypass and cardioplegic arrest in the development of postoperative AF. METHODS: Data from 114 patients undergoing CABG without cardiopulmonary bypass and cardioplegic arrest (off-pump) between October, 1998 and December, 2002 were evaluated for the occurrence of postoperative AF. Each patient was individually matched by gender, age (+/-3 years), left ventricle ejection fraction (+/-5%), history of myocardial infarction, unstable angina, and beta-blocker medication with patients undergoing CABG with cardiopulmonary bypass and cardioplegic arrest (on-pump) during the same period. The data from off-pump and on-pump groups were compared. RESULTS: Off-pump and on-pump groups had similar preoperative characteristics. The number of distal anastomoses was lower in the off-pump (2.3+/-0.9) than in the on-pump (3.9+/-1.1, (P<0.001) group. However, the incidence of postoperative AF in the off-pump (36.8%) and the on-pump groups (36.0%) did not differ from each other. Old age was the only independent predictor of AF after CABG. CONCLUSIONS: Neither cardiopulmonary bypass nor cardioplegic arrest increases the risk of postoperative AF after CABG.