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Published on: February 26, 2013
Atrial fibrillation after minimally invasive coronary artery bypass grafting: A retrospective, matched study
W E Cohn1, C A Sirois, R G Johnson
1Division of Cardiothoracic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, 02215, USA.
Insights
Minimally invasive cardiac surgery showed a slightly lower incidence of postoperative atrial fibrillation compared to conventional surgery. Further research is needed to understand the mechanisms and reduce this complication.
Area of Science:
- Cardiovascular Surgery
- Cardiac Arrhythmias
- Minimally Invasive Procedures
Background:
- Postoperative atrial fibrillation is a common complication after cardiac surgery, leading to increased morbidity and healthcare costs.
- Traditional factors implicated in atrial fibrillation include cardiopulmonary bypass, atrial manipulation, and ischemia.
- Comparing minimally invasive and conventional cardiac operations may elucidate the mechanisms of this complication.
Purpose of the Study:
- To compare the incidence of postoperative atrial fibrillation between minimally invasive direct coronary artery bypass grafting (MIDCAB) and conventional coronary artery bypass grafting (CABG).
- To investigate potential differences in the duration and management of atrial fibrillation between the two surgical approaches.
Main Methods:
- A cohort of 55 patients undergoing MIDCAB between January 1996 and September 1997 was evaluated for in-hospital atrial fibrillation.
- Data were compared to a matched control group of patients undergoing conventional CABG, with matching based on age and date of operation.
- Patients were assessed for the occurrence of atrial fibrillation and discharge on antiarrhythmic therapy.
Main Results:
- The overall incidence of postoperative atrial fibrillation was 26% in the MIDCAB group versus 34% in the conventional CABG group.
- In age-matched cohorts, the incidence was 24% for MIDCAB and 20% for conventional CABG (P = .6), a non-significant difference.
- The MIDCAB group was significantly less likely to be discharged with antiarrhythmic therapy (6 vs. 10 patients, P = .006).
Conclusions:
- The findings suggest that factors traditionally implicated in atrial fibrillation, such as cardiopulmonary bypass and atrial manipulation, may not be direct causes but rather related to the duration of the complication.
- Management strategies for postoperative atrial fibrillation should consider these insights.
- Minimally invasive approaches may offer advantages in reducing the need for antiarrhythmic medication post-surgery.
Background:
Atrial fibrillation after cardiac operations is a source of morbidity and resource consumption. Various factors common to cardiac operations have been cited as causal. Comparison of the incidences of atrial fibrillation after conventional cardiac operations and minimally invasive cardiac operations may provide some insight into the mechanisms of this complication.
Methods:
All patients undergoing minimally invasive direct coronary artery bypass grafting from January 26, 1996, through September 17, 1997, were evaluated for the occurrence of in-hospital postoperative atrial fibrillation. Data from these 55 patients were compared with data from a control cohort of patients undergoing conventional, solitary coronary artery bypass grafting. Each patient undergoing minimally invasive direct coronary artery bypass grafting was matched by age (+/- 3 years) and date of operation (+/- 7 days) with a patient undergoing conventional coronary artery bypass grafting.
Results:
During the period since the advent of minimally invasive direct coronary artery bypass grafting at our institution, the incidence of postoperative atrial fibrillation has been slightly lower among the patients undergoing this form of coronary artery bypass grafting (26%) than among the total population of patients undergoing conventional coronary artery bypass grafting (34%). Comparison of the age-matched groups, however, showed the incidence to be slightly but not significantly greater in the minimally invasive direct coronary artery bypass grafting cohort (13/55, 24%) than in the conventional coronary artery bypass grafting cohort (11/55, 20%; P =. 6). The minimally invasive direct coronary artery bypass grafting group was less likely to be discharged with antiarrhythmic therapy than was the conventional coronary artery bypass grafting group (6 versus 10; P =.006).
Conclusions:
According to these data, mechanisms traditionally implicated in atrial fibrillation after coronary artery bypass grafting, such as the use of cardiopulmonary bypass, mechanical manipulation of the atrium, and atrial ischemia, are not causal but may be related to the duration of the arrhythmic complication. Strategies directed toward management and reduction of the incidence of postoperative atrial fibrillation should be focused accordingly.
