title: Thoracic epidural anesthesia does not influence the occurrence of postoperative sustained atrial fibrillation.
abstract: BACKGROUND
  To evaluate whether thoracic epidural anesthesia (TEA) can reduce the incidence of atrial fibrillation (AF) after coronary artery bypass grafting (CABG).
  
  
  METHODS
  Forty-one patients undergoing CABG were treated with TEA intraoperatively and postoperatively. Another 80 patients served as the control group. The sympathetic and parasympathetic activities were evaluated by analysis of neuropeptides, catecholamines and heart rate variability (HRV), preoperatively and postoperatively.
  
  
  RESULTS
  Postoperative AF occurred in 31.7% of the TEA-treated patients and in 36.3% of the untreated patients (p = 0.77). TEA significantly suppressed sympathetic activity, as indicated by a less pronounced increase of norepinephrine and epinephrine (p = 0.03, p = 0.02) and a significant decrease of neuropeptide Y (p = 0.01) postoperatively in TEA-treated patients compared to untreated patients. The HRV variable expressing sympathetic activity was significantly lower and the postoperative increase in heart rate was significantly less in the TEA group than in the control group after surgery (p = 0.01, p < 0.001). Among patients developing AF, the maximal number of supraventricular premature beats per minute increased significantly in untreated patients postoperatively but remained unchanged in TEA-treated patients (p = 0.004 versus p = 0.86).
  
  
  CONCLUSIONS
  TEA has no effect on the incidence of postoperative sustained AF, despite a significant reduction in sympathetic activity.
authors.affiliation: Department of Surgical Sciences, University Hospital, Uppsala, Sweden. lena.jideus@kirurgi.uu.se
authors.forename: L
authors.initials: L
authors.lastname: Jidéus
authors.forename: P O
authors.initials: PO
authors.lastname: Joachimsson
authors.forename: M
authors.initials: M
authors.lastname: Stridsberg
authors.forename: M
authors.initials: M
authors.lastname: Ericson
authors.forename: H
authors.initials: H
authors.lastname: Tydén
authors.forename: L
authors.initials: L
authors.lastname: Nilsson
authors.forename: P
authors.initials: P
authors.lastname: Blomström
authors.forename: C
authors.initials: C
authors.lastname: Blomström-Lundqvist
mesh_terms: D000368:Aged; D000767:Anesthesia, Epidural; D001281:Atrial Fibrillation / Q000209:etiology* / Q000503:physiopathology; D002395:Catecholamines / Q000097:blood; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009479:Neuropeptides / Q000097:blood; D010275:Parasympathetic Nervous System / Q000503:physiopathology; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D013564:Sympathetic Nervous System / Q000503:physiopathology
chemical_list: D002395:Catecholamines; D009479:Neuropeptides