The Incidence of Atrial Fibrillation after On-Pump Versus Off-Pump Coronary Artery Bypass Grafting
Effects of pump and off-pump CABG on postoperative atrial fibrillation
Keywords:Postoperative atrial fibrillation, effects of cardiopulmonary bypass, coronary artery bypass surgery, rhythm disorders
Background: This study aimed to investigate the incidence of postoperative atrial fibrillation (POAF) in patients undergoing off-pump versus on-pump coronary artery bypass grafting (CABG) under cardiopulmonary bypass (CPB).
Methods: A total of 3,197 consecutive patients (1,816 males, 1,381 females; mean age: 60.8 ± 9.8 years) with preoperative sinus rhythm who underwent CABG at a cardiovascular surgery clinic between November 2009 and March 2014 retrospectively were analyzed. Of the patients, 1,680 underwent on-pump and 1,517 underwent off-pump cardiac surgery. Data, including demographic characteristics, preoperative risk factors, preoperative medications, laboratory test results, postoperative data and complications, and mortality and morbidity rates, were recorded.
Results: According to the multivariate analysis, the type of operation, number of anastomoses, right coronary artery or right coronary posterior descending artery graft, vasopressor therapy (epinephrine, norepinephrine), operation duration, age >60 years, hypertension, length of hospital stay >4 days, and obstructive sleep apnea syndrome (OSAS) were the independent predictors of POAF after CABG. Our study results suggest that on-pump CABG under CPB is correlated with POAF.
Conclusion: We recommend using off-pump CABG in select cases to minimize the risk of POAF.
Allessie MA, Boyden PA, Camm AJ, et al. 2001. Pathophysiology and prevention of atrial fibrillation. Circulation. 103:769-77.
An J, Shi F, Liu S, Ma J, Ma Q. 2017. Preoperative statins as modifiers of cardiac and inflammatory outcomes following coronary artery bypass graft surgery: a meta-analysis. Interact Cardiovasc Thorac Surg. 25(6):958-965.
Andrews TC, Reimold SC, Berlin JA, Antman EM. 1991. Prevention of supraventricular arrhythmias after coronary artery bypass surgery. A meta-analysis of randomized control trials. Circulation. 84(5 Suppl):III236-III244.
Berliner D, Hallbaum M, Bauersachs J. 2018. Current drug therapy for heart failure with reduced ejection fraction. Medikamentöse Therapie der Herzinsuffizienz mit reduzierter systolischer LV-Funktion. Herz. 43(5):383-391.
Bruins P, te Velthuis H, Yazdanbakhsh AP, et al. 1997. Activation of the complement system during and after cardiopulmonary bypass surgery: postsurgery activation involves C-reactive protein and is associated with postoperative arrhythmia. Circulation. 96(10):3542-3548.
Burgess DC, Kilborn MJ, Keech AC. 2006. Interventions for prevention of post-operative atrial fibrillation and its complications after cardiac surgery: a meta-analysis. Eur Heart J. 27(23):2846-2857.
Chelazzi C, Villa G, De Gaudio AR. 2011. Postoperative atrial fibrillation. ISRN Cardiol 2011:203179.
Chen YB, Shu J, Yang WT, et al. 2012. Meta-analysis of randomized trials comparing the effectiveness of on-pump and off-pump coronary artery bypass. Chin Med J (Engl). 125(2):338-344.
Diamantis E, Kyriakos G, Quiles-Sanchez LV, Farmaki P, Troupis T. 2017. The Anti-Inflammatory Effects of Statins on Coronary Artery Disease: An Updated Review of the Literature. Curr Cardiol Rev. 13(3):209-216.
Dzeshka MS, Shahid F, Shantsila A, Lip GYH. 2017. Hypertension and Atrial Fibrillation: An Intimate Association of Epidemiology, Pathophysiology, and Outcomes. Am J Hypertens. 30(8):733-755.
Fakanya WM, Tothill IE. 2014. Detection of the inflammation biomarker C-reactive protein in serum samples: towards an optimal biosensor formula. Biosensors (Basel). 4(4):340-357.
Gasparova I, Kubatka P, Opatrilova R, et al. 2017. Perspectives and challenges of antioxidant therapy for atrial fibrillation. Naunyn Schmiedebergs Arch Pharmacol. 390(1):1-14.
Hashemzadeh K, Dehdilani M, Dehdilani M. 2013. Does Off-pump Coronary Artery Bypass Reduce the Prevalence ofAtrial Fibrillation? J Cardiovasc Thorac Res. 5(2):45-49.
Hogue CW Jr, Hyder ML. 2000. Atrial fibrillation after cardiac operation: risks, mechanisms, and treatment. Ann Thorac Surg. 69(1):300-306.
Kosuma P, Wachirasrisirikul S, Jedsadayanmata A. 2018. Attributable Costs of Postoperative Atrial Fibrillation among Patients Undergoing Cardiac Surgery. Cardiol Res Pract. 2018:3759238.
Lau YF, Yiu KH, Siu CW, Tse HF. 2012. Hypertension and atrial fibrillation: epidemiology, pathophysiology and therapeutic implications. J Hum Hypertens. Oct;26(10):563-9.
Lee SH, Lee H, Park JK, et al. 2017. Gender Difference in the Long-Term Clinical Implications of New-Onset Atrial Fibrillation after Coronary Artery Bypass Grafting. Yonsei Med J. 58(6): 1119–1127.
Lefer DJ. 2002. Statins as potent anti-inflammatory drugs. Circulation. 106: 2041 –2042.
Liuzzo G, Biasucci LM, Gallimore JR, Grillo RL, Rebuzzi AG, Pepys MB, Maseri A. 1994. The prognostic value of C - reactive protein and serum amyloid a protein in severe unstable angina. N Engl Med. 331:417-24.
Maesen B, Nijs J, Maessen J, Allessie M, Schotten U. 2012. Postoperative atrial fibrillation: a maze of mechanisms. Europace. 14(2):159-174.
Mooe T, Gullsby S, Rabben T, Eriksson P. 1996. Sleep-disordered breathing: a novel predictor of atrial fibrillation after coronary artery bypass surgery. Coronary Artery Disease. 7(6):475–478.
Patel D, Mohanty P, Di Biase L, et al. 2010. Safety and efficacy of pulmonary vein antral isolation in patients with obstructive sleep apnea: the impact of continuous positive airway pressure. Circulation: Arrhythmia and Electrophysiology. 3(5):445–451.
Patti G, Chello M, Candura D. 2006. Randomized Trial of Atorvastatin for Reduction of Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery Results of the ARMYDA-3 (Atorvastatin for Reduction of Myocardial Dysrhythmia After cardiac surgery) Study. Circulation. 114:1455–1461.
Pedersen OD, Bagger H, Kober L, Torp- Pedersen C. 1999. Trandolapril reduces the incidence of atrial fibrillation after acute myocardial infarction in patients with left ventricular disfunction. Circulation. 100: 376 – 380.
Sabzi F, Zokaei AH, Moloudi AR. 2011. Predictors of atrial fibrillation following coronary artery bypass grafting. Clin Med Insights Cardiol. 5.67-75.
Sajja LR, Mannam G, Sompalli S, et al. 2004. Does multi- vessel off-pump coronary artery bypass graftingreduce postoperative morbidity compared to on-pump CABG? Ind J Thorac Cardiovasc Surg. 20:173-177.
Wang X, Yao L, Ge L, et al. 2017. Pharmacological interventions for preventing post-operative atrial fibrillation in patients undergoing cardiac surgery: a network meta-analysis protocol. BMJ Open. 7(12):e018544.
Workman AJ. 2010. Cardiac adrenergic control and atrial fibrillation. Naunyn Schmiedebergs Arch Pharmacol. 381:235–49.
Yanagawa B, Puskas JD. 2016. Off-Pump Coronary Artery Bypass Grafting Operative Techniques in Thoracic and Cardiovascular Surgery Volume 21, Issue 1, spring Pages 2-19.
Yehc ET, Anderson HV, Pasceri V, Willerson JT. 2001. C-Reactive Protein Linking Inflammation to Cardiovascular Complications. Circulation. 104; 974-975.
Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S. 2014. Epidemiology of atrial fibrillation: European perspective. Clin Epidemiol. 6.213-220.
How to Cite
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).