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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

Published on: February 28, 2012

Predictors of atrial fibrillation after conventional and beating heart coronary surgery: A prospective, randomized

R Ascione1, M Caputo, G Calori

  • 1Bristol Heart Institute, Bristol Royal Infirmary, Bristol, UK.

Circulation
|September 27, 2000
PubMed

Insights

Cardiopulmonary bypass (CPB) with cardioplegic arrest significantly increases the risk of postoperative atrial fibrillation (AF) after coronary artery bypass grafting (CABG). Off-pump surgery on a beating heart reduces AF occurrence.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Clinical Research

Background:

  • Atrial fibrillation (AF) is a common complication following coronary artery bypass grafting (CABG), increasing patient morbidity.
  • The exact causes of AF after CABG are not fully understood, and current prevention strategies are insufficient.

Purpose of the Study:

  • To investigate the role of cardiopulmonary bypass (CPB) and cardioplegic arrest in the development of postoperative AF.
  • To compare the incidence of AF in patients undergoing on-pump versus off-pump CABG.

Main Methods:

  • A prospective randomized study involving 200 patients undergoing CABG.
  • Patients were assigned to either on-pump conventional surgery with CPB and cardioplegic arrest or off-pump surgery on a beating heart.
  • Postoperative AF was monitored for 72 hours using automated arrhythmia detection and subsequent clinical observation.

Main Results:

  • Thirty-nine of 100 on-pump patients developed sustained postoperative AF, compared to only 8 of 100 off-pump patients (P=0.001).
  • Univariate analysis identified CPB with cardioplegic arrest, inotropic support, intubation time, chest infection, and hospital stay as AF predictors.
  • Multivariate regression analysis confirmed CPB with cardioplegic arrest as the sole independent predictor of postoperative AF (OR 7.4).

Conclusions:

  • Cardiopulmonary bypass (CPB) incorporating cardioplegic arrest is the primary independent risk factor for postoperative atrial fibrillation in patients undergoing coronary revascularization.
  • Off-pump CABG may be a strategy to reduce the incidence of postoperative AF.
Abstract

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