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


  • Gokhan Arslan University of Health Sciences, Gulhane Faculty of Medicine, Department of Cardiovascular Surgery, Ankara, Turkey
  • Gokhan Erol Gulhane Training and Research Hospital, Ankara, Turkey
  • Hakan Kartal Gulhane Training and Research Hospital, Ankara, Turkey
  • Ertan Demirdas Gulhane Training and Research Hospital, Ankara, Turkey
  • Cengiz Bolcal University of Health Sciences, Gulhane Faculty of Medicine, Department of Cardiovascular Surgery, Ankara, Turkey



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

Arslan, G., Erol, G., Kartal, H., Demirdas, E., & Bolcal, C. (2021). 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 . The Heart Surgery Forum, 24(4), E645-E650.