Does off-pump coronary artery bypass reduce the incidence of post-operative atrial fibrillation? A question revisited

Abstract

Atrial fibrillation (AF) is the most common post-operative complication in patients undergoing coronary artery bypass grafting, with an increased incidence associated with advancing age. This study aims to determine whether off-pump coronary artery bypass (OPCAB) reduces the incidence of AF in a generalized population (mean age <70 years). A meta-analysis was performed including all randomised and propensity score matched non-randomised studies published between 2001 and 2003 reporting a comparison between the two techniques in a generalised patient group (average age <70 years). The primary outcome of interest was post-operative AF. Sensitivity analysis was performed to evaluate consistency of the calculated treatment effect. Fourteen studies fulfilled our inclusion criteria, including a total of 16,505 subjects. The incidence of AF was 19% (1612/8265) in the off-pump group versus 24% (1976/8240) in the on-pump group. When considering only the 11 randomised studies (2207 subjects), we found a significant reduction in the incidence of post-operative AF in the off-pump group using a random-effect model (odds ratio (OR)=0.60, 95% confidence interval (CI)=0.45-0.82, and chi-square of heterogeneity=18.02, P=0.05). Sensitivity analysis highlighted one randomised study causing funnel plot asymmetry, exclusion of which resulted in a significant reduction in the incidence of post-operative AF in the off-pump group (OR=0.71, 95% CI=0.57-0.90), with a non-significant heterogeneity of 3.91 (P=0.92). When only studies of high quality were considered (898 patients), no significant difference was seen between on and off-pump groups (OR=0.78, 95% CI=0.57-1.07, and heterogeneity=0.53, P=0.91). This may be due to small number of patients in this group. Our results suggest that although OPCAB surgery may reduce the incidence of post-operative AF in a generalised population (age <70 years) this finding is not clearly supported by high quality randomised trials. Although previous evidence suggests that the incidence of post-operative AF is reduced in an elderly population (>70 years) with off-pump surgery, our results show that the evidence is less clear in a younger population group. The question of whether off-pump surgery in this patient group results in a lower rate of post-operative AF remains to be answered by further high quality randomised research.

Emergency Coronary Artery Bypass Graft Surgery for Acute Coronary Syndrome

“…Because we could no find a significant difference in atrial fibrillation between BH and CA strategies for stable patients, it can be speculated that the severity of preoperative myocardial damage triggers the development of atrial fibrillation and BH surgery might have an influence on that. 32 Stroke rate and the incidence of acute renal failure were also significantly reduced in BH patients, although most of the BH operations were performed with CPB support. It might be speculated that a faster postoperative cardiac recovery and preserved pulsatility have a protective potential.…”

Fibrilação atrial no pós-operatório de cirurgia de revascularização do miocárdio: características do perfil clínico associadas a óbitos hospitalares

“…The presence of cerebrovascular accident in these patients causes a five-fold increase in the rate of in-hospital death 19,20 .…”

Atrial Gap Junctions, NF-κB and Fibrosis in Patients Undergoing Coronary Artery Bypass Surgery: The Relationship with Postoperative Atrial Fibrillation

“…Recently, beating heart CABG has become widely used and many studies have indicated that this procedure may decrease the incidence of post-CABG AF [8,9,10,11]. However, the molecular mechanisms underlying the protective effect of beating heart surgery remains unclear.…”