(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
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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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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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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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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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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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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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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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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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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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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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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E. W. Jansen Invited Commentary Asian Cardiovasc Thorac Ann, June 1, 2002; 10(2): 158 - 159. [Full Text] [PDF]
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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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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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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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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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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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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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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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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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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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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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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]
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