Article Text

Download PDFPDF
New insights into onset mechanisms of atrial fibrillation and flutter after coronary artery bypass graft surgery
  1. A D Taylor1,
  2. J G Groen2,
  3. S L Thorn1,
  4. C T Lewis1,
  5. A J Marshall1
  1. 1The South West Cardiothoracic Centre, Derriford Hospital, Plymouth, UK
  2. 2Vitatron Medical BV, 6951 KL Dieren, Netherlands
  1. Correspondence to:
    Dr A D Taylor, Cardiology Department, The South West Cardiothoracic Centre, Derriford Hospital, Plymouth PL6 8DH, UK;


Objective: To determine by means of a monitoring study the onset mechanisms of atrial fibrillation (AF) after coronary artery bypass graft surgery (CABG).

Patients and design: During elective CABG, 81 patients had one bipolar atrial and one ventricular epicardial electrode attached. These were connected to a Vitatron 900E external pacing device, which monitored the patients for four consecutive days. 12 lead ECGs were obtained if AF was clinically detected and Holter ECGs were obtained in 8 (33%) of these patients.

Results: 24 patients (30%) developed paroxysmal AF (50%), atrial flutter (17%), or both (33%). The number of AF episodes varied from 1–169 a day (median 5) and were usually of short duration (median 2.25 minutes). Pacemaker diagnostics showed much intrapatient and interpatient variability in onset mechanisms but the majority of AF onsets (71%) were preceded by either short runs of AF or multiple atrial extrasystoles. The final trigger was a conducted atrial extrasystole in 72% of cases. There were no bradycardic triggers. The Holter ECGs confirmed the device’s data.

Conclusions: The onset mechanisms of post-CABG AF are dominated by atrial extrasystoles with multiple atrial extrasystoles and short runs of AF preceding the main AF onset in the majority of cases. These results have major implications for the development of new preventive pacing algorithms.

  • coronary artery bypass graft surgery
  • atrial fibrillation
  • atrial flutter
  • onset mechanisms
  • atrial based pacing
  • AF, atrial fibrillation
  • AFL, atrial flutter
  • AFT, atrial fibrillation therapy
  • CABG, coronary artery bypass graft surgery
  • DOR, detailed onset report
  • PAF, paroxysmal atrial fibrillation

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.