Original Articles: Cardiovascular
Is atrial fibrillation caused by extracorporeal circulation?

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Abstract

Background. Atrial fibrillation is the most common rhythm disturbance encountered after open heart operations, with a reported incidence up to 40%. Despite its high incidence and clinical relevance its etiology remains obscure. It has been hypothesized that atrial fibrillation might be related to extracorporeal circulation. We performed a retrospective study (January 1, 1997 to December 31, 1997) comparing the incidence of atrial fibrillation in 3 groups of patients revascularized with and without extracorporeal circulation.

Methods. The first group comprised patients with coronary artery disease operated on with standard revascularization technique with cardiopulmonary bypass (n = 685). The second group included patients who had minimally invasive coronary artery bypass grafting without the use of extracorporeal circulation (n = 19). Patients in the third group had off-pump transmyocardial laser revascularization (n = 19).

Results. There was no significant difference in the incidence of atrial fibrillation in the group that had conventional coronary artery bypass and the group that had minimally invasive coronary artery bypass without cardiopulmonary bypass. The incidence of atrial fibrillation was significantly lower in the transmyocardial laser group compared with the other two groups.

Conclusions. The present study found that postoperative atrial fibrillation is not caused solely by extracorporeal circulation, but patients who had transmyocardial laser revascularization had a significantly lower incidence of atrial fibrillation.

Section snippets

Patients and methods

This retrospective study was based on the hospital’s database and included detailed preoperative, intraoperative, and postoperative data from patients operated on between January 1997 and December 1997. Physicians prospectively collected clinical data on cardiac history and comorbidity. Intraoperative and postoperative data, including complications and adverse effects, were assessed. Table 1shows clinical characteristics of the patients in the three groups.

All patients were monitored routinely

Results

There were no significant differences between the groups with respect to age and gender. Reoperations were more frequent in the group that had TMLR than in the other groups (p < 0.01) (Table 1). Patients in the CABG group received a mean of 3.6 peripheral and 1.9 central anastomoses, with a mean aortic cross-clamp time and perfusion time of 29 and 52 minutes, respectively. In the MICABG group the numbers were 1.9 and 0.8, respectively. A mean of 47 laser holes were made with the high-energy

Comment

The pathophysiologic mechanisms responsible for the high incidence of AF after cardiac operations are unknown, but AF far exceeds the prevalence in the general surgical population. The occurrence of AF might therefore be related to the procedure. Studies have focused on the contribution of ECC to postoperative AF. The present study showed that cardiac operation irrespective of the use of ECC could precipitate AF.

Many studies have attempted to determine possible etiologic factors in the

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Copyright © 1999 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.