Ventricular conduction defects and atrial fibrillation after coronary artery bypass grafting. Multivariate analysis of preoperative, intraoperative and postoperative variables

Abstract

Preoperative, intraoperative and postoperative variables, which might play a role in the development of ventricular conduction defects (VCD) and atrial fibrillation (AF) following coronary artery bypass grafting (CABG), were evaluated in 236 consecutive patients. VCD and AF developed postoperatively in 15.5% of patients: 4.5% had VCD (subgroup A), 11.0% had AF (subgroup B). In 84.5% of patients VCD and AF did not occur (subgroup C). Univariate analysis showed statistically significant differences between subgroups A and C with respect to: left main significant stenoses and number of diseased vessels. Bypass pump time and aortic cross-clamp time were significantly longer in subgroup B. Multivariate analysis showed a significantly greater incidence of left main disease and of right coronary artery occlusion associated with significant stenosis of the proximal left anterior descending artery in subgroup A. In subgroup B, the duration of aortic cross-clamp time was significantly higher. Ischaemic injury, with increasing duration of cardioplegic arrest, seems to play a key role in the development of AF. Nonhomogeneous cardioplegic delivery to critical areas of myocardium, and particularly to the specialized conducting system, may cause VCD after CABG.

Atrial fibrillation post-cardiac surgery: changing perspectives

“…Indeed, there is a 24% rise in the frequency of postoperative AF for every additional 5-years of age 6 . We should not forget other factors which may predispose the patient to AF, including operative trauma from surgical dissection and manipulation, inflammation (with or without pericarditis), increased atrial pressure from postoperative ventricular stunning, chemical stimulation from catecholamines and other inotropic agents and reflex sympathetic activation from volume loss, anaemia or pain 7,8 . Historically, postoperative AF was considered a relatively benign, transient and generally selflimiting complication of cardiac surgery.…”

Atrial Fibrillation After Cardiac Surgery: Incidence, Risk Factors, and Economic Burden

“…[4][5][6] Several factors, including the type of surgical procedure, patient demographics, criteria used for diagnosis, and methods of electrocardiographic (ECG) monitoring, may account for the wide range of POAF incidence reported in the literature. [7][8][9] POAF is near 10% when the diagnosis is based on scheduled 12-lead ECGs, but more than 40% when continuous ECG recording or Holter monitoring are used and episodes lasting less than 10 minutes 7,8 are included in the analysis. Otherwise, the incidence of POAF has been reported to range between 16% and 30% when the diagnosis is made on the basis of patients' symptoms.…”

Factores determinantes en la aparición de fibrilación auricular post-cirugía de revascularización miocárdica: Un estudio prospectivo

“…En nuestra serie, un t'PAo >57 min, se asoció a 4 veces más riesgo de desarrollar FA (Figura 1 E). Aunque casuísticas pequeñas no han podido demostrar esta asociación 14 , estudios de mayor tamaño sí lo han hecho 13,15 .…”