CLINICAL STUDY: CARDIAC SURGERY
Atrial fibrillation after minimally invasive direct coronary artery bypass surgery
Jacqueline E. Tamis-Holland, MD, FACC*,
Peter Homel, PhD*,
Mohammed Durani, MD*,
Muhammed Iqbal, MD*,
Anton Sutandar, MD*,
Bruce P. Mindich, MD and
Jonathan S. Steinberg, MD, FACC*
* Arrhythmia Service, Division of Cardiology, St. Luke’s-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York, USA
Valley Hospital, Columbia University College of Physicians and Surgeons, New York, New York, USA
Manuscript received November 22, 1999;
revised manuscript received June 1, 2000,
accepted July 31, 2000.
Reprint requests and correspondence: Dr. Jacqueline E. Tamis- Holland, Women’s Cardiac Care Center, St. Luke’s–Roosevelt Hospital Center, Department of Cardiology, S & R-3, 1111 Amsterdam Ave., New York, NY 10025
jtamis{at}SLRHC.org
OBJECTIVES
The study compared the adjusted risk for developing atrial fibrillation (AF) after minimally invasive direct coronary artery bypass surgery (MIDCAB) and coronary artery bypass graft surgery (CABG).
BACKGROUND
Atrial fibrillation results in increased morbidity and delays hospital discharge after CABG. Recently, MIDCAB has been explored as an alternative to CABG. Because of differences in surgical approach between the two procedures, the incidence of AF may differ.
METHODS
Randomly selected patients undergoing CABG and MIDCAB were examined. Baseline variables and postoperative course were recorded through review of medical record data.
RESULTS
The MIDCAB patients were younger than CABG patients (64 ± 12 vs. 67 ± 10, p < 0.04) and had less extensive coronary artery disease (53% of MIDCAB vs. 3% of CABG had single-vessel disease, while 15% of MIDCAB vs. 69% of CABG had triple-vessel disease, p < 0.001 for overall group comparisons). No other differences in clinical or treatment data were noted. Postoperative AF occurred less often after MIDCAB (23% vs 39%, p = 0.02). Other significant factors associated with postoperative AF included age (p = 0.0024), prior AF (p = 0.0007), left main disease (p = 0.01), number of vessels bypassed (p = 0.009), absence of postoperative beta-blocker therapy (p = 0.0001), and a serious postoperative complication (p = 0.0018). Because of differences between CABG and MIDCAB patients, multivariate logistic analysis was performed to determine independent predictors of postoperative AF. The type of surgery (CABG vs. MIDCAB) was no longer a significant predictor of postoperative AF (estimated relative risk for AF in CABG vs. MIDCAB patients: 1.57, 95% confidence interval (0.82–2.52).
CONCLUSIONS
Although AF appears to be less common after MIDCAB than after CABG, the lower incidence is due to different clinical characteristics of patients undergoing these procedures.
|
Abbreviations and Acronyms
| | AF | = atrial fibrillation | | CABG | = coronary artery bypass graft surgery | | MIDCAB | = minimally invasive direct coronary artery bypass surgery |
|
This article has been cited by other articles:
|
|
|
|
 
D. N. Wijeysundera, W. S. Beattie, G. Djaiani, V. Rao, M. A. Borger, K. Karkouti, and R. J. Cusimano
Off-Pump Coronary Artery Surgery for Reducing Mortality and Morbidity: Meta-Analysis of Randomized and Observational Studies
J. Am. Coll. Cardiol.,
September 6, 2005;
46(5):
872 - 882.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. Enc, B. Ketenci, D. Ozsoy, G. Camur, I. Kayacioglu, S. Terzi, and S. Cicek
Atrial fibrillation after surgical revascularization: is there any difference between on-pump and off-pump?
Eur. J. Cardiothorac. Surg.,
December 1, 2004;
26(6):
1129 - 1133.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. A. Gupte, E. A. Zias, M. R. Sarabu, and M. S. Wolin
Role of Prostaglandins in Mediating Differences in Human Internal Mammary and Radial Artery Relaxation Elicited by Hypoxia
J. Pharmacol. Exp. Ther.,
November 1, 2004;
311(2):
510 - 518.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. J. Drew, R. M. Califf, M. Funk, E. S. Kaufman, M. W. Krucoff, M. M. Laks, P. W. Macfarlane, C. Sommargren, S. Swiryn, and G. F. Van Hare
Practice Standards for Electrocardiographic Monitoring in Hospital Settings: An American Heart Association Scientific Statement From the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young: Endorsed by the International Society of Computerized Electrocardiology and the American Association of Critical-Care Nurses
Circulation,
October 26, 2004;
110(17):
2721 - 2746.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Zimarino, S. Gallina, M. Di Fulvio, M. Di Mauro, G. Di Giammarco, R. De Caterina, and A. M. Calafiore
Intraoperative ischemia and long-term events after minimally invasive coronary surgery
Ann. Thorac. Surg.,
July 1, 2004;
78(1):
135 - 141.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Athanasiou, O. Aziz, O. Mangoush, A. Weerasinghe, S. Al-Ruzzeh, S. Purkayastha, J. Pepper, M. Amrani, B. Glenville, and R. Casula
Do off-pump techniques reduce the incidence of postoperative atrial fibrillation in elderly patients undergoing coronary artery bypass grafting?
Ann. Thorac. Surg.,
May 1, 2004;
77(5):
1567 - 1574.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. S. Steinberg
Postoperative atrial fibrillation: a billion-dollar problem
J. Am. Coll. Cardiol.,
March 17, 2004;
43(6):
1001 - 1003.
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Hakala, O. Pitkanen, and J. Hartikainen
Cardioplegic arrest does not increase the risk of atrial fibrillation after coronary artery bypass surgery
Eur. J. Cardiothorac. Surg.,
March 1, 2004;
25(3):
415 - 418.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R A Archbold and N P Curzen
Off-pump coronary artery bypass graft surgery: the incidence of postoperative atrial fibrillation
Heart,
October 1, 2003;
89(10):
1134 - 1137.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. L. Creswell and R. J. Damiano Jr
Postoperative atrial fibrillation: An old problem crying for new solutions
J. Thorac. Cardiovasc. Surg.,
March 1, 2003;
125(90030):
S20 - 23.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. L. Creswell and R. J. Damiano Jr
Postoperative atrial fibrillation: An old problem crying for new solutions
J. Thorac. Cardiovasc. Surg.,
April 1, 2001;
121(4):
638 - 641.
[Full Text]
[PDF]
|
|
|
|
