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Does intermittent aortic cross clamping decrease the incidence of atrial fibrillation after coronary bypass surgery?
Serdar Akgun1, Kanat Ozisik, Ali Kutsal
1City Hospital, Department of Cardiovascular Surgery, Ankara, Turkey. drsakgun@yahoo.com
Insights
Intermittent aortic cross-clamping (IACC) significantly reduces the incidence of postoperative atrial fibrillation (AF) after coronary artery bypass grafting (CABG) compared to hypothermic cardioplegic solution (HCS). This finding suggests IACC may offer a protective effect against AF development post-CABG.
Area of Science:
- Cardiovascular Surgery
- Cardiac Arrhythmias
- Thoracic Surgery
Background:
- Atrial fibrillation (AF) is a common complication following coronary artery bypass grafting (CABG).
- Postoperative AF increases patient morbidity, prolongs hospital stays, and elevates healthcare costs.
- Identifying strategies to mitigate AF development after CABG is crucial.
Purpose of the Study:
- To compare the efficacy of intermittent aortic cross-clamping (IACC) versus hypothermic cardioplegic solution (HCS) in preventing postoperative AF after CABG.
- To evaluate the impact of different myocardial preservation techniques on AF incidence.
Main Methods:
- A retrospective study of 345 patients undergoing CABG between April 2004 and August 2005.
- Patients were divided into two groups: HCS (n=212) and IACC (n=173).
- Preoperative characteristics and postoperative AF rates were analyzed.
Main Results:
- The incidence of postoperative AF was significantly lower in the IACC group (11.05%) compared to the HCS group (21.52%).
- Diabetes mellitus was more prevalent in the HCS group.
- Postoperative calcium-antagonist use (HCS group) and smoking (IACC group) were identified as independent predictors of AF.
Conclusions:
- Intermittent aortic cross-clamping (IACC) is associated with a reduced incidence of postoperative atrial fibrillation after CABG compared to hypothermic cardioplegic solution (HCS).
- IACC, potentially through induced ventricular fibrillation, may have a protective effect against AF.
- Further research into the mechanisms underlying IACC's effect on AF is warranted.
Abstract:
Atrial fibrillation (AF) is the most common arrhythmia after coronary artery bypass grafting (CABG). AF is a vexing problem that causes morbidity, prolongs hospital stay, and increases costs. Numerous factors have been suggested to play a role in the development of AF. The aim of this study was to evaluate the effect of intermittent aortic cross clamping (IACC) compared with hypothermic cardioplegic solution (HCS) in the development of postoperative AF. We evaluated data obtained from 345 patients undergoing CABG with HCS (HCS group, n = 212) and IACC (IACC group, n = 173) between April 2004 and August 2005. Diabetes mellitus was observed more often in the HCS group (P < .05), otherwise both groups had similar preoperative characteristics including sex, age, the number of distal anastomoses, left ventricle ejection fraction, history of myocardial infarction, and use of beta-blocker medication. The only statistically significant difference between the groups was higher postoperative Ca-antagonist use in the HCS group. Rates of postoperative AF, however, were significantly lower in the IACC group (21.52%) than that in the HCS group (11.05%; P < .01). Postoperative Ca-antagonist use in the HCS group and smoking in the IACC group were independent predictors of AF after CABG. The incidence of postoperative AF after CABG with IACC was reduced compared with HCS. IACC with ventricular fibrillation may exert a counteractive effect against AF.
