Predictors of atrial fibrillation after conventional and beating heart coronary surgery : A prospective, randomized study

• Published in: Circulation (New York, N.Y.) Vol. 102; no. 13; pp. 1530 - 1535
• Main Authors: ASCIONE, Raimondo, CAPUTO, Massimo, CALORI, Giliola, LLOYD, Clinton T, UNDERWOOD, Malcom J, ANGELINI, Gianni D
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 26.09.2000; American Heart Association, Inc
• Subjects: Adult; Aged; Aged, 80 and over; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Biological and medical sciences; Coronary Artery Bypass; Female; Heart Arrest - physiopathology; Heart Arrest - surgery; Humans; Male; Medical sciences; Middle Aged; Predictive Value of Tests; Prospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Human; Arrhythmia; Pathogenesis; Atrial fibrillation; Cardiovascular disease; Excitability disorder; Cardiopulmonary bypass; Treatment; Aortocoronary; Bypass; Heart disease; Surgery; Anesthesia; Complication
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.CIR.102.13.1530

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