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Updated: Aug 20, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Predictors of atrial fibrillation after off-pump coronary artery bypass graft surgery
Alberto Zangrillo1, Giovanni Landoni, Donatella Sparicio
1Department of Cardiovascular Anesthesia, IRCCS San Raffaele Hospital, Milan, Italy.
Insights
Postoperative atrial fibrillation remains common after off-pump coronary artery bypass grafting. Key predictors include older age, reoperation, and ramus medius revascularization, highlighting areas for improved patient outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Clinical Outcomes
Background:
- Atrial fibrillation is a frequent complication following coronary artery bypass graft (CABG) surgery.
- This arrhythmia can cause hemodynamic instability, extended hospital stays, and increase stroke risk.
- While older age is a known risk factor, robust predictive models for postoperative atrial fibrillation (POAF) are lacking.
Purpose of the Study:
- To identify perioperative factors associated with new-onset atrial fibrillation in patients undergoing off-pump coronary artery bypass grafting (OPCABG).
Main Methods:
- Prospective, observational study conducted at a university tertiary care hospital.
- Included 160 consecutive patients undergoing OPCABG.
- No specific interventions were applied beyond standard surgical care.
Main Results:
- The incidence of POAF was 20.6% (33 patients).
- Independent predictors identified by multivariate analysis were reintervention (OR 26.8), ramus medius revascularization (OR 3.9), and age (OR 1.069 per year).
- All patients achieved sinus rhythm by discharge; one hospital death occurred.
Conclusions:
- POAF occurs at a high rate even with OPCABG.
- Older age, ramus medius grafting, and redo operations are significant predictors of POAF.
- Potential mechanisms include left atrial stretching due to heart manipulation during lateral wall revascularization.
Objective:
Atrial fibrillation is the most common complication after coronary artery bypass graft surgery. This arrhythmia may lead to hemodynamic compromise, prolonged hospitalization, and increased risk for cerebral thromboembolism. Older age is the only variable consistently associated with the development of postoperative atrial fibrillation; however, no strong predictive model exists. The purpose of this study was to identify perioperative characteristics associated with new-onset atrial fibrillation in patients undergoing off-pump coronary artery bypass grafting.
Design:
Prospective, observational.
Setting:
University tertiary care hospital.
Participants:
One hundred sixty consecutive patients undergoing off-pump coronary artery bypass grafting.
Interventions:
None.
Measurements And Main Results:
Incidence of postoperative atrial fibrillation was the major outcome. Atrial fibrillation occurred in 33 patients (20.6%). Multivariate analysis identified reintervention (odds ratio 26.8), revascularization of the ramus medianus (odds ratio 3.9), and age (odds ratio 1.069 per year) as the only independent predictors of postoperative atrial fibrillation. All patients were in sinus rhythm at hospital discharge. One hospital death was noted.
Conclusions:
Despite the less invasive approach, the incidence of postoperative atrial fibrillation is high after off-pump coronary artery bypass grafting. Older age, grafting of the ramus medianus, and a redo operation were predictors of new-onset postoperative atrial fibrillation. It is possible that left atrial stretching with heart dislocation during revascularization of the lateral wall could lead to postoperative atrial fibrillation.
