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Atrial fibrillation after blood and crystalloid cardioplegia in CABG patients

E J Pehkonen1, P J Mäkynen, M J Kataja

  • 1Department of Thoracic and Cardiovascular Surgery, Tampere University Hospital, Finland.

The Thoracic and Cardiovascular Surgeon
|August 1, 1995
PubMed

Insights

Cold blood cardioplegia increased postoperative atrial fibrillation (AF) risk after bypass surgery. Crystalloid cardioplegia was associated with lower AF incidence, suggesting reperfusion injury contributes to AF development.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Arrhythmia Research

Background:

  • Supraventricular arrhythmias, particularly atrial fibrillation (AF), are common complications following cardiac surgery.
  • Understanding the factors influencing postoperative AF is crucial for improving patient outcomes.

Purpose of the Study:

  • To investigate the influence of cold blood versus cold crystalloid cardioplegia on the incidence of postoperative atrial fibrillation (AF) after coronary artery bypass grafting (CABG).
  • To explore potential mechanisms, including myocardial protection and reperfusion injury, associated with AF development.

Main Methods:

  • Ninety-eight patients undergoing elective CABG were randomized to receive either cold blood (n=49) or cold crystalloid (n=49) cardioplegia.
  • Patients were monitored for seven days postoperatively for the development of AF.
  • Cardiac enzyme leakage (CK-MB), spontaneous myocardial beating, and volume of cardioplegia administered were assessed.

Main Results:

  • The incidence of AF was significantly higher in the blood-cardioplegia group (21 patients) compared to the crystalloid-cardioplegia group (9 patients) (p < 0.01).
  • Patients who developed AF showed smaller CK-MB enzyme leaks and more frequent spontaneous beating, suggesting adequate ventricular protection.
  • Lower volumes of cardioplegia and later onset of AF in the blood group suggest a potential role for atrial-level reperfusion injury.

Conclusions:

  • Cold blood cardioplegia is associated with a higher risk of postoperative atrial fibrillation compared to cold crystalloid cardioplegia.
  • Atrial reperfusion injury may contribute to the development of AF after cardiac surgery.
  • Optimizing cardioplegia delivery and utilizing postoperative beta-blockers may reduce AF incidence.

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