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Off-pump coronary artery bypass graft surgery: the incidence of postoperative atrial fibrillation
  1. R A Archbold1,
  2. N P Curzen2
  1. 1Department of Cardiology, St Bartholomew’s Hospital, London, UK
  2. 2Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK
  1. Correspondence to:
    Dr R A Archbold, Department of Cardiology, St Bartholomew’s Hospital, Dominion House, 60 Bartholomew Close, West Smithfield, London EC1A 7BE, UK;
    Andrew.Archbold{at}bartsandthelondon.nhs.uk

Abstract

Atrial fibrillation (AF) occurs in one quarter to one third of patients after coronary artery bypass graft surgery (CABG). Conventional CABG uses cardiopulmonary bypass, a process that is itself associated with a systemic vascular inflammatory response that contributes to postoperative morbidity. The avoidance of cardiopulmonary bypass is associated with a significant reduction in the inflammatory response and in the release of markers of myocardial necrosis when compared with conventional CABG. There is speculation that off-pump CABG may reduce the incidence of postoperative AF through reduced trauma, ischaemia, and inflammation. Current data, however, do not emphatically answer the question of whether the incidence of post-CABG AF is reduced by off-pump surgery. The evidence from both observational and randomised studies is conflicting and many studies have weaknesses in design, conduct, or interpretation. It remains an attractive hypothesis that postoperative AF is reduced by off-pump CABG but more robust data are required.

  • atrial fibrillation
  • off-pump coronary artery bypass surgery
  • AF, atrial fibrillation
  • CABG, coronary artery bypass graft surgery
  • CPB, cardiopulmonary bypass
  • MIDCAB, minimally invasive direct coronary artery bypass

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