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Updated: Aug 30, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Operative factors that contribute to post-operative atrial fibrillation: insights from a prospective randomized trial
G J Murphy1, R Ascione, M Caputo
1Department of Cardiac Surgery, Bristol Heart Institute, Bristol Royal Infirmary, Bristol BS2 8HW, UK.
Insights
Off-pump coronary artery bypass grafting significantly reduces postoperative atrial fibrillation (AF) compared to on-pump surgery. This approach lowers AF incidence, morbidity, and hospital stay, highlighting the impact of cardiopulmonary bypass on AF development.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Atrial fibrillation (AF) is a frequent complication after cardiac surgery.
- AF increases postoperative morbidity, hospital stay, and healthcare costs.
Purpose of the Study:
- To compare the incidence of postoperative AF in patients undergoing off-pump versus on-pump coronary artery bypass grafting (CABG).
- To identify independent predictors of postoperative AF.
Main Methods:
- A randomized study comparing off-pump CABG (n=100) with conventional on-pump CABG (n=100).
- Postoperative arrhythmias detected via automated monitoring and clinical observations.
- AF defined as irregular rhythm without P waves >10 minutes.
Main Results:
- Off-pump CABG showed a significantly lower AF incidence (11% vs. 45%, P < 0.001).
- Reduced blood usage, pneumonia, inotrope needs, and hospital/ICU stay in the off-pump group.
- Cardiopulmonary bypass and cardioplegic arrest identified as independent predictors of AF.
Conclusions:
- Off-pump CABG significantly reduces postoperative AF incidence.
- Inflammation from bypass, ischemia, and atrial manipulation contribute to AF.
- Benefits may be greatest in high-risk patients.
Abstract:
Atrial fibrillation (AF) is the most common complication following cardiac surgery and is associated with significant increases in postoperative morbidity, length of stay and cost of care. In a randomized study we assessed the impact of coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) (off-pump, n = 100), compared to conventional (on-pump, n = 100) CABG, on the frequency of postoperative AF. Arrhythmias were detected using an automated arrhythmia detector for the first 72 hours following surgery and by four hourly clinical observations thereafter. AF was defined as an irregular narrow complex rhythm (in the absence of bundle branch block) with absence of discrete P waves lasting greater then 10 minutes. There was a significant reduction in the incidence of postoperative AF in the off-pump group (11% versus 45%, P < 0.001) in addition to significant reductions in blood usage, postoperative pneumonia, inotrope requirements, and hospital and intensive care unit stay. Univariate analysis identified all these variables as risk factors for AF, however multivariate regression analysis identified CPB and cardioplegic arrest as the only independent predictor of postoperative AF (OR 7.4; 95% CI 3.4 to 17.9). This study therefore suggests that the inflammatory response to bypass, myocardial ischaemia and atrial cannulation are significant contributory factors to the development of AF following cardiac surgery. In the light of more recent trials it is apparent that this benefit may be most marked in patients with multiple perioperative risk factors for postoperative AF.
