Stenosis of the Right Coronary Artery and Retrograde Cardioplegia Predispose Patients to Atrial Fibrillation after Coronary Artery Bypass Grafting

Erkki Pehkonen; Eva‐Liisa Honkonen; Pekka J. Mäkynen; Matti Kataja; Matti Tarkka

doi:10.1055/s-2007-1010206

June 1, 1998The Thoracic and Cardiovascular Surgeon

Stenosis of the Right Coronary Artery and Retrograde Cardioplegia Predispose Patients to Atrial Fibrillation after Coronary Artery Bypass Grafting

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Why the study?

Does retrograde cardioplegia delivery increase postoperative atrial fibrillation in CABG patients with RCA stenosis compared to antegrade delivery?

Structured PICO

Does retrograde cardioplegia delivery increase postoperative atrial fibrillation in CABG patients with RCA stenosis compared to antegrade delivery?

P

Population

94 CABG patients, including 60 with high-grade right coronary artery (RCA) lesion and 34 controls without RCA lesion.

I

Intervention

Retrograde delivery of cold blood cardioplegia (with or without catheter cuff) or combined antegrade and retrograde delivery.

C

Comparator

Antegrade delivery of cold blood cardioplegia.

O

Outcome

Postoperative atrial fibrillation episodes.hard clinical

Retrograde cardioplegia delivery in CABG patients with RCA stenosis significantly increases the risk of postoperative atrial fibrillation, suggesting poorer atrial myocardial protection.

Implication

Supports preferring antegrade cardioplegia in CABG patients with RCA lesions to reduce postoperative atrial fibrillation; challenges routine retrograde delivery in this subgroup.

Abstract

It is assumed that stenosis of the right coronary artery (RCA) predisposes CABG patients, by way of incomplete atrial myocardial protection, to postoperative atrial fibrillation (AF). Sixty patients with high-grade RCA lesion were randomized into four groups according to the technique of delivery of cold blood cardioplegia: antegrade, retrograde, retrograde without catheter cuff, and combined antegrade and retrograde. As controls, 34 patients without RCA lesion were randomized to receive antegrade or retrograde cardioplegia. Postoperative atrial fibrillation episodes were recorded. Patients with RCA lesion were more prone to develop AF; odds ratio (OR)=3.75 (95% confidence interval [CI]=1.22-11.5). Retrograde delivery in these patients was more often associated with AF, OR=4.97 (95% CI = 1.02-24.1). Other risk factors for AF were an increasing number of preoperative infarcts (p < 0.05) and more advanced coronary artery disease (p < 0.05). Prolonged stay in the intensive care unit (p < 0.001) and occurrence of postoperative ventricular tachycardia (p < 0.05) were associated with AF. RCA stenosis and retrograde cardioplegia delivery in RCA-affected patients were risk factors for postoperative atrial fibrillation. Retrograde cardioplegia may offer poorer protection at the atrial level.