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Atrial fibrillation after coronary artery bypass grafting without cardiopulmonary bypass
J Siebert1, J Rogowski, D Jagielak
1Department of Cardiac Surgery Institute of Cardiology, Medical University of Gdansk, Debinki 7, 80-211, Gdansk, Poland.
Insights
Atrial fibrillation is a common complication after heart surgery, occurring in about 25-29% of patients undergoing myocardial revascularization without cardiopulmonary bypass. The incidence did not significantly differ between off-pump and conventional bypass techniques.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Atrial fibrillation is a frequent complication following cardiac surgery, leading to prolonged hospital stays and increased morbidity.
- Coronary artery bypass grafting (CABG) is increasingly performed without cardiopulmonary bypass (CPB) using off-pump coronary artery bypass grafting (OPCABG) or minimally invasive direct vision coronary artery bypass grafting (MIDCABG) to reduce surgical trauma.
Purpose of the Study:
- To determine the frequency of atrial fibrillation in patients undergoing myocardial revascularization without cardiopulmonary bypass.
- To compare the incidence of atrial fibrillation between OPCABG, MIDCABG, and conventional CABG with CPB.
Main Methods:
- A retrospective analysis of 48 patients who underwent myocardial revascularization without CPB (24 OPCABG, 24 MIDCABG).
- Continuous ECG monitoring during ICU stay and 24-h ECG monitoring after discharge.
- Daily 12-lead ECGs and additional ECGs upon symptom occurrence were performed.
Main Results:
- Atrial fibrillation occurred in 25% of MIDCABG patients and 29% of OPCABG patients.
- The incidence of atrial fibrillation was 18% in patients who underwent CABG with CPB.
- No statistically significant difference in atrial fibrillation incidence or postoperative complications was observed between the groups.
Conclusions:
- Atrial fibrillation is a common complication after myocardial revascularization, irrespective of whether cardiopulmonary bypass is used.
- The type of myocardial revascularization procedure (on-pump vs. off-pump) does not appear to influence the occurrence of atrial fibrillation.
Objective:
Atrial fibrillation is the most common complication after heart surgery. It rarely has a fatal outcome but causes patient instability, prolongs hospital stay, or even is the reason for perioperative infarction. Although conventional coronary artery bypass grafting (CABG) with cardiopulmonary bypass has excellent short-term and long-term results, the number of coronary operations on a beating heart without cardiopulmonary bypass is still growing. To reduce surgical trauma, off-pump coronary artery bypass grafting via sternotomy (OPCABG) or minimally invasive direct vision coronary artery bypass grafting (MIDCABG) via small thoracotomy are performed. The aim of this study was to estimate the frequency of atrial fibrillation in patients after myocardial revascularization without cardiopulmonary bypass.
Methods:
A retrospective analysis of 48 patients undergoing myocardial revascularization without cardiopulmonary bypass was performed. Twenty-four patients underwent OPCABG and 24 were operated using the MIDCABG technique. The incidence of cardiac arrhythmias was analyzed since operation to the fourth postoperative day. Each patient had continuous ECG monitoring with option of arrhythmia analysis during ICU stay. After discharge from ICU 24-h ECG monitor studies were carried out. Surface 12-lead ECG was accomplished once a day, and additionally each time symptoms of cardiac arrhythmia occurred. Risk factors of atrial fibrillation were estimated.
Results:
Atrial fibrillation occurred in 25% of patients after MIDCABG, in 29% after OPCABG, and in 18% after CABG with cardiopulmonary bypass. This difference has no statistical significance. Risk factors and incidence of postoperative complications were comparable in all groups.
Conclusions:
Atrial fibrillation is a common complication after procedures of myocardial revascularization, performed with or without cardiopulmonary bypass. The occurrence is not dependent on the type of operation.