Atrial fibrillation after surgical revascularization: is there any difference between on-pump and off-pump?
OBJECTIVE
Postoperative atrial fibrillation (AF) is still frequent complication after cardiac surgery in spite of the improvements in the surgical procedures. There is still controversy whether or not, the absence of cardiopulmonary bypass results in a lower incidence of AF.


METHODS
Six hundred and seventy patients that underwent revascularization by using in situ LIMA for single vessel disease were included in this retrospective study and the patients were divided in two groups. Group I included 328 patients who underwent complete revascularization with cardiopulmonary bypass and group II consisted of 342 patients who underwent complete revascularization without cardiopulmonary bypass. Then, the incidence and predictive perioperative factors of AF in two groups were determined and compared with each other.


RESULTS
There were no significant differences between two groups with respect to the preoperative demographic characteristics of the patients. The incidence of postoperative AF was determined as 16.1% after on-pump and 14.6% after off-pump revascularization. Avoiding cardiopulmonary bypass did not decrease the incidence of postoperative AF. Sex, age over 65 years, prophylactic beta-blocker usage and left ventricular dysfunction were independent predictive factors in group I (r2=0.51; P<0.001). However, only age over 65 years and prophylactic beta-blocker usage were independent predictive factors in group II (r2=0.59; P<0.01). The rates of AF in both groups were decreased by using prophylactic beta-blocker usage (P=0.05 in group I, P<0.001 in group II).


CONCLUSIONS
There is no reduction of AF rate in myocardial revascularization without cardiopulmonary bypass. However, prophylactic beta-blocker usage decreases the incidence of AF after both on-pump and off-pump myocardial revascularization.
Enc
Yavuz
Y
Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey. erenenc@superonline.com
Ketenci
Bulent
B
Ozsoy
Deniz
D
Camur
Gercek
G
Kayacioglu
Ilyas
I
Terzi
Sait
S
Cicek
Sertac
S
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology* / Q000503:physiopathology; D002315:Cardiopulmonary Bypass / Q000379:methods*; D001026:Coronary Artery Bypass / Q000379:methods*; D047549:Coronary Artery Bypass, Off-Pump; D003327:Coronary Disease / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000503:physiopathology / Q000601:surgery
D000319:Adrenergic beta-Antagonists