Predictors of Atrial Fibrillation After Conventional and Beating Heart Coronary Surgery: A Prospective, Randomized Study - Predictors of Atrial Fibrillation After Conventional and Beating Heart Coronary Surgery: A Prospective, Randomized Study
Predictors of Atrial Fibrillation After Conventional and Beating Heart Coronary Surgery: A Prospective, Randomized Study.
A prospective, randomized study was designed to define the role of cardiopulmonary bypass (CPB) and cardioplegic arrest in the pathogenesis of atrial fibrillation (AF) after coronary artery bypass surgery (CABG).
Patients Enrolled: 200
Two hundred patients were prospectively randomized to on-pump conventional surgery (100 patients, 79 men, mean age 63 years) with normothermic CPB and cardioplegic arrest of the heart or off-pump surgery (100 patients, 82 men, mean age 63 years) on the beating heart. An automated arrhythmia detector was used to monitor heart rhythm continuously during the first 72 hours after surgery followed by routine clinical observation and resumption of continuous monitoring if AF occurred. Perioperative factors significantly associated with AF on univariate analysis were included in a stepwise logistic regression model to ascertain their independent association with the occurrence of AF.
There were no significant baseline differences between groups. Thirty-nine patients in the on-pump group and eight patients in the off-pump group developed postoperative sustained AF (p = 0.001). Stepwise multivariate regression analysis identified CPB inclusive of cardioplegic arrest as the only independent predictor of postoperative AF (OR 7.4; CI 3.4-17.9).
CPB inclusive of cardioplegic arrest is a strong independent predictor of postoperative AF in patients undergoing CABG.
The current study in a relatively small number of patients suggests that off pump surgery in carefully selected patients has the potential for reducing post-CABG complications, length of stay and resource utilization compared to conventional on-pump CABG, at least in part driving by a reduction in postoperative atrial fibrillation. Further, studies are needed in large number of patients undergoing CABG to confirm the findings of this study and to further establish if this clinical advantage is linked to better graft patency and/or survival (off-pump vs. conventional CABG).
1. Ascione R, Caputo M, Calori G, Lloyd CT, Underwood MJ, Angelini GD. Circulation 2000;102:1530-5.
Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention
Keywords: Cardiopulmonary Bypass, Coronary Artery Bypass, Logistic Models, Length of Stay
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