Abstract
ObjectiveTo determine the incidence of postoperative atrial fibrillation in patients undergoing on-pump and off-pump coronary artery bypass grafting.MethodsA retrospective study with analysis of 230 medical records between January 2011 and October 2013 was conducted.ResultsFifty-six (24.3%) out of the 230 patients were female. The average age of patients undergoing on-pump coronary artery bypass grafting was 59.91±8.62 years old, and off-pump was 57.16±9.01 years old (P=0.0213). The average EuroSCORE for the on-pump group was 3.37%±3.08% and for the off-pump group was 3.13%±3% (P=0.5468). Eighteen (13.43%) patients who underwent off-pump coronary artery bypass grafting developed postoperative atrial fibrillation, whereas for the onpump group, 19 (19.79%) developed this arrhythmia, with no significant difference between the groups (P=0.1955).ConclusionOff-pump coronary artery bypass grafting did not reduce the incidence of atrial fibrillation in the postoperative period. Important predictors of risk for the development of this arrhythmia were identified as: patients older than 70 years old and presence of atrial fibrillation in perioperative period in both groups, and non-use of beta-blockers drugs postoperatively in the on-pump group.
Highlights
Atrial fibrillation (AF) is a common complication after cardiac surgery, affecting about 10% to 40% of patients undergoing Coronary Artery Bypass Grafting (CABG)[1,2,3]
It was observed a higher consumption of blood products in the on-pump when compared to off-pump CABG (64.58% vs. 20.9%; P
Off-pump group showed higher tendency to develop AF, there was no statistical difference between groups (P=0.0560)
Summary
Atrial fibrillation (AF) is a common complication after cardiac surgery, affecting about 10% to 40% of patients undergoing Coronary Artery Bypass Grafting (CABG)[1,2,3]. The postoperative AF represents a four-fold increased risk of stroke in comparison to the evolution of patients who remain in sinus rhythm[5] It is meaningfully associated with postoperative complications, such as heart failure, hypoxia, hypovolemia, sepsis and electrolyte disturbances[6], as well as it doubles the overall mortality rate in the postoperative period[7]. The intraoperative factors can be consequent to cardiac ischemia and inflammation inherent to the complexity of the surgical technique In these situations, the time of aortic clamping, handling and atrial cannulation and the use of cardiopulmonary bypass (CPB) are reported as factors that support the installation of AF[8]. Some of the conditions associated with the onset of AF after surgery include: infections, prolonged mechanical ventilation, hemodynamic instability, myocardial ischemia and low cardiac output in the postoperative period[10]
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