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Circulation. 2000;102:1530-1535

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(Circulation. 2000;102:1530.)
© 2000 American Heart Association, Inc.


Clinical Investigation and Reports

Predictors of Atrial Fibrillation After Conventional and Beating Heart Coronary Surgery

A Prospective, Randomized Study

Raimondo Ascione, MD; Massimo Caputo, MD; Giliola Calori, MD; Clinton T. Lloyd, FRCS; Malcom J. Underwood, FRCS; Gianni D. Angelini, FRCS

From Bristol Heart Institute, Bristol Royal Infirmary, Bristol, UK (R.A., M.C., C.T.L., M.J.U., G.D.A.), and Epidemiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy (G.C.).

Correspondence to Prof Gianni D. Angelini, Bristol Heart Institute, Bristol Royal Infirmary, Bristol BS2 8HW, UK. E-mail N.Holloway-Dee{at}bristol.ac.uk

Background—Atrial fibrillation (AF) increases the morbidity of CABG. The pathophysiology is uncertain, and its prevention remains suboptimal. This prospective, randomized study was designed to define the role of cardiopulmonary bypass (CPB) and cardioplegic arrest in the pathogenesis of this complication.

Methods and Results—Two hundred patients were prospectively randomized to (1) on-pump conventional surgery [(100 patients, 79 men, mean age 63 (40 to 77) years)] with normothermic CPB and cardioplegic arrest of the heart or (2) off-pump surgery [(100 patients, 82 men, mean age 63 (38 to 86) years)] on the beating heart. Heart rate and rhythm were continuously monitored with an automated arrhythmia detector during the first 72 hours after surgery. Thereafter, routine clinical observation was performed and continuous monitoring restarted in the case of arrhythmia. The association of perioperative factors with AF was investigated by univariate analysis. Significant variables were then included into a stepwise logistic regression model to ascertain their independent influence on the occurrence of AF. There were no significant baseline differences between groups. Thirty-nine patients in the on-pump group and 8 patients in the off-pump group had postoperative sustained AF (P=0.001). Univariate analysis showed that CPB inclusive of cardioplegic arrest, postoperative inotropic support, intubation time, chest infection, and hospital length of stay were predictors of AF (all P<0.05). However, stepwise multivariate regression analysis identified CPB inclusive of cardioplegic arrest as the only independent predictor of postoperative AF (OR 7.4; CI 3.4 to 17.9).

Conclusions—CPB inclusive of cardioplegic arrest is the main independent predictor of postoperative AF in patients undergoing coronary revascularization.


Key Words: prevention • tachyarrhythmias • fibrillation • coronary disease • cardiopulmonary bypass




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A. Parolari, F. Alamanni, A. Cannata, M. Naliato, L. Bonati, P. Rubini, F. Veglia, E. Tremoli, and P. Biglioli
Off-pump versus on-pump coronary artery bypass: meta-analysis of currently available randomized trials
Ann. Thorac. Surg., July 1, 2003; 76(1): 37 - 40.
[Abstract] [Full Text] [PDF]


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Eur. J. Cardiothorac. Surg.Home page
D. J. Goldstein, R. B. Beauford, B. Luk, R. Karanam, T. Prendergast, F. Sardari, P. Burns, and C. Saunders
Multivessel off-pump revascularization in patients with severe left ventricular dysfunction
Eur. J. Cardiothorac. Surg., July 1, 2003; 24(1): 72 - 80.
[Abstract] [Full Text] [PDF]


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J. Thorac. Cardiovasc. Surg.Home page
M. Caputo, B. Reeves, G. Marchetto, B. Mahesh, K. Lim, and G. D. Angelini
Radial versus right internal thoracic artery as a second arterial conduit for coronary surgery: early and midterm outcomes
J. Thorac. Cardiovasc. Surg., July 1, 2003; 126(1): 39 - 47.
[Abstract] [Full Text] [PDF]


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J. Thorac. Cardiovasc. Surg.Home page
R. Ascione and G. D. Angelini
Off-pump coronary artery bypass surgery: The implications of the evidence
J. Thorac. Cardiovasc. Surg., April 1, 2003; 125(4): 779 - 781.
[Full Text] [PDF]


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J. Thorac. Cardiovasc. Surg.Home page
L. L. Creswell and R. J. Damiano Jr
Postoperative atrial fibrillation: An old problem crying for new solutions
J. Thorac. Cardiovasc. Surg., March 1, 2003; 125(90030): S20 - 23.
[Full Text] [PDF]


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Ann. Thorac. Surg.Home page
R. Ascione, M. Caputo, and G. D. Angelini
Off-pump coronary artery bypass grafting: not a flash in the pan
Ann. Thorac. Surg., January 1, 2003; 75(1): 306 - 313.
[Abstract] [Full Text] [PDF]


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SEMIN CARDIOTHORAC VASC ANESTHHome page
C. S. Hollenbeak, D. L. Morris, and M. C. Sinclair
Is Off-pump Coronary Artery Bypass Graft Surgery Cost-Saving?
Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2002; 6(4): 325 - 329.
[Abstract] [PDF]


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Ann. Thorac. Surg.Home page
M. Caputo, M. Yeatman, P. Narayan, G. Marchetto, R. Ascione, B. C. Reeves, and G. D. Angelini
Effect of off-pump coronary surgery with right ventricular assist device on organ function and inflammatory response: a randomized controlled trial
Ann. Thorac. Surg., December 1, 2002; 74(6): 2088 - 2095.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
K.-B. Kim, C. H. Kang, W.-I. Chang, C. Lim, J. H. Kim, B. M. Ham, and Y. L. Kim
Off-pump coronary artery bypass with complete avoidance of aortic manipulation
Ann. Thorac. Surg., October 1, 2002; 74(4): S1377 - 1382.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
M. Caputo, A. J. Bryan, R. Capoun, B. Mahesh, F. Ciulli, J. Hutter, and G. D. Angelini
The evolution of training in Off-Pump coronary surgery in a single institution
Ann. Thorac. Surg., October 1, 2002; 74(4): S1403 - 1407.
[Abstract] [Full Text] [PDF]


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CirculationHome page
R. Ascione, B. C. Reeves, K. Rees, and G. D. Angelini
Effectiveness of Coronary Artery Bypass Grafting With or Without Cardiopulmonary Bypass in Overweight Patients
Circulation, October 1, 2002; 106(14): 1764 - 1770.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
S. C. Stamou, K. A. Jablonski, A. J. Pfister, P. C. Hill, M. K.C. Dullum, A. S. Bafi, S. W. Boyce, K. R. Petro, and P. J. Corso
Stroke after conventional versus minimally invasive coronary artery bypass
Ann. Thorac. Surg., August 1, 2002; 74(2): 394 - 399.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
R. Ascione, B. C. Reeves, M. H. Chamberlain, A. K. Ghosh, K. H.H. Lim, and G. D. Angelini
Predictors of stroke in the modern era of coronary artery bypass grafting: a case control study
Ann. Thorac. Surg., August 1, 2002; 74(2): 474 - 480.
[Abstract] [Full Text] [PDF]


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Eur. J. Cardiothorac. Surg.Home page
R. Ascione, K. Rees, K. Santo, M.H. Chamberlain, G. Marchetto, F. Taylor, and G.D. Angelini
Coronary artery bypass grafting in patients over 70 years old: the influence of age and surgical technique on early and mid-term clinical outcomes
Eur. J. Cardiothorac. Surg., July 1, 2002; 22(1): 124 - 128.
[Abstract] [Full Text] [PDF]


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J. Thorac. Cardiovasc. Surg.Home page
E. Villa, A. Moneta, and F. Donatelli
Optimizing neurologic outcome in coronary bypass surgery
J. Thorac. Cardiovasc. Surg., July 1, 2002; 124(1): 210 - 211.
[Full Text] [PDF]


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PerfusionHome page
R. Ascione, S. Al-Ruzzeh, K. Amer, and G. D Angelini
Subsystem organ function during coronary surgery
Perfusion, July 1, 2002; 17(4): 295 - 303.
[Abstract] [PDF]


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Ann. Thorac. Surg.Home page
M. H. Chamberlain, R. Ascione, B. C. Reeves, and G. D. Angelini
Evaluation of the effectiveness of off-pump coronary artery bypass grafting in high-risk patients: an observational study
Ann. Thorac. Surg., June 1, 2002; 73(6): 1866 - 1873.
[Abstract] [Full Text] [PDF]


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Asian Cardiovasc. Thorac. Ann.Home page
E. W. Jansen
Invited Commentary
Asian Cardiovasc Thorac Ann, June 1, 2002; 10(2): 158 - 159.
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Ann. Thorac. Surg.Home page
M. Yeatman, M. Caputo, P. Narayan, A. Kumar Ghosh, R. Ascione, I. Ryder, and G. D. Angelini
Intracoronary shunts reduce transient intraoperative myocardial dysfunction during off-pump coronary operations
Ann. Thorac. Surg., May 1, 2002; 73(5): 1411 - 1417.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
R. Ascione, G. Nason, S. Al-Ruzzeh, C. Ko, F. Ciulli, and G. D. Angelini
Coronary revascularization with or without cardiopulmonary bypass in patients with preoperative nondialysis-dependent renal insufficiency
Ann. Thorac. Surg., December 1, 2001; 72(6): 2020 - 2025.
[Abstract] [Full Text] [PDF]


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CirculationHome page
M. Yacoub
Off-Pump Coronary Bypass Surgery: In Search of an Identity
Circulation, October 9, 2001; 104(15): 1743 - 1745.
[Full Text] [PDF]


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CirculationHome page
D. van Dijk, A. P. Nierich, E. W.L. Jansen, H. M. Nathoe, W. J.L. Suyker, J. C. Diephuis, W.-J. van Boven, C. Borst, E. Buskens, D. E. Grobbee, et al.
Early Outcome After Off-Pump Versus On-Pump Coronary Bypass Surgery: Results From a Randomized Study
Circulation, October 9, 2001; 104(15): 1761 - 1766.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
F. Toraman, E. H. Karabulut, H. C. Alhan, S. Dagdelen, and S. Tarcan
Magnesium infusion dramatically decreases the incidence of atrial fibrillation after coronary artery bypass grafting
Ann. Thorac. Surg., October 1, 2001; 72(4): 1256 - 1262.
[Abstract] [Full Text] [PDF]


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Ann. Thorac. Surg.Home page
R. Ascione, G. Iannelli, K. H.H. Lim, H. Imura, and N. Spampinato
One-stage coronary and abdominal aortic operation with or without cardiopulmonary bypass: early and midterm follow-up
Ann. Thorac. Surg., September 1, 2001; 72(3): 768 - 774.
[Abstract] [Full Text] [PDF]


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CirculationHome page
M. Galinanes, M. Loubani, M. Caputo, R. Ascione, G. Calori, C. T. Lloyd, M. J. Underwood, and G. D. Angelini
Is Cardiopulmonary Bypass Really the Cause of Postoperative Atrial Fibrillation? Response
Circulation, August 14, 2001; 104 (7): e36 - e36.
[Full Text] [PDF]


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CirculationHome page
D. H. Spodick, R. Ascione, M. Oberhoff, M. Caputo, G. Marchetto, C. T. Lloyd, M. J. Underwood, G. D. Angelini, and G. Calori
Predictors of Atrial Fibrillation After Conventional and Beating Heart Coronary Surgery Response
Circulation, June 26, 2001; 103 (25): e130 - e130.
[Full Text] [PDF]


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J. Thorac. Cardiovasc. Surg.Home page
L. L. Creswell and R. J. Damiano Jr
Postoperative atrial fibrillation: An old problem crying for new solutions
J. Thorac. Cardiovasc. Surg., April 1, 2001; 121(4): 638 - 641.
[Full Text] [PDF]


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Ann. Thorac. Surg.Home page
M. Caputo, M. H. Chamberlain, F. Ozalp, M. J. Underwood, F. Ciulli, and G. D. Angelini
Off-pump coronary operations can be safely taught to cardiothoracic trainees
Ann. Thorac. Surg., April 1, 2001; 71(4): 1215 - 1219.
[Abstract] [Full Text] [PDF]


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Eur. J. Cardiothorac. Surg.Home page
M. Yeatman, M. Caputo, R. Ascione, F. Ciulli, and G. D. Angelini
Off-pump coronary artery bypass surgery for critical left main stem disease: safety, efficacy and outcome
Eur. J. Cardiothorac. Surg., March 1, 2001; 19(3): 239 - 244.
[Abstract] [Full Text] [PDF]