Atrial Fibrillation after Off-Pump versus On-Pump Coronary Artery Bypass Grafting Surgery

Background Among postoperative arrhythmic complications, atrial fibrillation (AF) exhibits the greatest prevalence after coronary artery bypass grafting (CABG). This study investigates the comparative prevalence of AF between on-pump and off-pump techniques. Aim To compare the POAF (post-operative atrial fibrillation) incidence between off-pump and on-pump CABG Methods A randomized (simple) cohort study prospectively investigated the influence of surgical practice in CABG, contrasting off-pump (OPCAB) and on-pump (ONCAB) methods, on the early postoperative occurrence of atrial fibrillation (POAF), defined as within the first 24 hours post-surgery. In a cohort of 128 consecutive patients (95 off-pump, 33 on-pump), the study compared groups based on preoperative factors (age, left ventricular ejection fraction < 40%, raised creatinine, hypertension, and graft location (right coronary (Rt), left circumflex arteries (LCX)) and the incidence of the POAF. Results ONCAB showed approximately twice the POAF incidence (30.3% versus 15.8% OPCAB, though not significantly (p=0.071). ONCAB had nearly double the POAF incidence (30.3% vs. 15.8%), though this difference was not statistically significant (p=0.071). Additionally, age and grafting of LCX/Rt. were significant predictors for POAF in the OPCAB group, while renal impairment was significant in both groups. Conclusion We conclude that Renal Impairment is a key predictor of postoperative adverse events (POAFS) across CABG techniques. However, age and LCX/Rt. Grafting significantly increases the risk of postoperative atrial fibrillation (POAF), particularly after OPCAB. ONCAB, while showing higher POAF incidence numerically, presents a distinct risk factor profile, emphasising the importance of a surgical approach in POAF risk assessment.