|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
|
|
|
|||||||||
|
|||||||||||
|
J Am Coll Cardiol, 2004; 43:994-1000, doi:10.1016/j.jacc.2003.07.055 © 2004 by the American College of Cardiology Foundation |
* Heart and Vascular Research Center, MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio, USA
Department of Cardiothoracic Surgery, MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio, USA
Elyria Memorial Hospital Regional Medical Center, Campus of the Cleveland Clinic Foundation, Cleveland, Ohio, USA
Manuscript received February 28, 2003; revised manuscript received July 10, 2003, accepted July 14, 2003.
* Reprint requests and correspondence: Dr. Kara J. Quan, Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, Ohio 44109, USA.
kquan{at}metrohealth.org
OBJECTIVES: The goal of this study was to determine if parasympathetic nerves in the anterior fat pad (FP) can be stimulated at the time of coronary artery bypass surgery (CABG), and if dissection of this FP decreases the incidence of postoperative atrial fibrillation (AF).
BACKGROUND: The human anterior epicardial FP contains parasympathetic ganglia and is often dissected during CABG. Changes in parasympathetic tone influence the incidence of AF.
METHODS: Fifty-five patients undergoing CABG were randomized to anterior FP preservation (group A) or dissection (group B). Nerve stimulation was applied to the FP before and after surgery. Sinus cycle length (CL) was measured during stimulation. The incidence of postoperative AF was recorded.
RESULTS: Of the 55 patients enrolled, 26 patients were randomized to group A, and 29 patients were randomized to group B. In all of the 55 patients, the FP was identified before initiating cardiopulmonary bypass by CL prolongation with stimulation (865.5 ± 147.9 ms vs. 957.9 ± 155.1 ms, baseline vs. stimulation, p < 0.001). In group A, stimulation at the conclusion of surgery increased sinus CL (801.8 ± 166.4 ms vs. 890.9 ± 178.2 ms, baseline vs. stimulation, p < 0.001). In group B, repeat stimulation failed to increase sinus CL (853.6 ± 201.6 ms vs. 841.4 ± 198.4 ms, baseline vs. stimulation, p = NS). The incidence of postoperative AF in group A (7%) was significantly less than that in group B (37%) (p < 0.01).
CONCLUSIONS: This is the first study demonstrating that direct stimulation of the human anterior epicardial FP slows sinus CL. This parasympathetic effect is eliminated with FP dissection. Preservation of the human anterior epicardial FP during CABG decreases incidence of postoperative AF.
| ||||||||||||
This article has been cited by other articles:
|
|
 |
|
  T. Yamada, H. T. McElderry, H. Doppalapudi, Y. Murakami, Y. Yoshida, N. Yoshida, T. Okada, N. Tsuboi, Y. Inden, T. Murohara, et al. Idiopathic Ventricular Arrhythmias Originating From the Aortic Root: Prevalence, Electrocardiographic and Electrophysiologic Characteristics, and Results of Radiofrequency Catheter Ablation J. Am. Coll. Cardiol., July 8, 2008; 52(2): 139 - 147. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Armour Potential clinical relevance of the 'little brain' on the mammalian heart Exp Physiol, February 1, 2008; 93(2): 165 - 176. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Arora, J. S. Ulphani, R. Villuendas, J. Ng, L. Harvey, S. Thordson, F. Inderyas, Y. Lu, D. Gordon, P. Denes, et al. Neural substrate for atrial fibrillation: implications for targeted parasympathetic blockade in the posterior left atrium Am J Physiol Heart Circ Physiol, January 1, 2008; 294(1): H134 - H144. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Oral and F. Morady Autonomic Innervation, Atrial Electrogram Morphology, and Atrial Fibrillation J. Am. Coll. Cardiol., October 2, 2007; 50(14): 1332 - 1334. [Full Text] [PDF]
|
|
|
|
 |
|
 W. L Baker and C M. White Post-Cardiothoracic Surgery Atrial Fibrillation: A Review of Preventive Strategies Ann. Pharmacother., April 1, 2007; 41(4): 587 - 598. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. M. White, S. Sander, C. I. Coleman, R. Gallagher, H. Takata, C. Humphrey, N. Henyan, E. L. Gillespie, and J. Kluger Impact of Epicardial Anterior Fat Pad Retention on Postcardiothoracic Surgery Atrial Fibrillation Incidence: The AFIST-III Study J. Am. Coll. Cardiol., January 23, 2007; 49(3): 298 - 303. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. C. Burgess, M. J. Kilborn, and A. C. Keech Interventions for prevention of post-operative atrial fibrillation and its complications after cardiac surgery: a meta-analysis Eur. Heart J., December 1, 2006; 27(23): 2846 - 2857. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Kollar, S. D. Lick, K. N. Vasquez, and V. R. Conti Relationship of Atrial Fibrillation and Stroke After Coronary Artery Bypass Graft Surgery: When is Anticoagulation Indicated? Ann. Thorac. Surg., August 1, 2006; 82(2): 515 - 523. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Amar, H. Zhang, P. M. Heerdt, B. Park, M. Fleisher, and H. T. Thaler Statin Use Is Associated With a Reduction in Atrial Fibrillation After Noncardiac Thoracic Surgery Independent of C-Reactive Protein Chest, November 1, 2005; 128(5): 3421 - 3427. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. H. Jones The Year in Cardiovascular Surgery J. Am. Coll. Cardiol., May 3, 2005; 45(9): 1517 - 1528. [Full Text] [PDF]
|
|
|
|
|
|
G. Bisleri, T. Bottio, J. A. Morgan, and C. Muneretto Preservation of the anterior fat pad and incidence of postoperative atrial fibrillation following coronary surgery J. Am. Coll. Cardiol., April 19, 2005; 45(8): 1308 - 1308. [Full Text] [PDF]
|
|
|
|
|
|
J. E. Cummings, I. Gill, R. Akhrass, M. Dery, L. A. Biblo, and K. J. Quan Reply J. Am. Coll. Cardiol., April 19, 2005; 45(8): 1308 - 1309. [Full Text] [PDF]
|
|
|
|
 |
|
 C. A. Palin, R. Kailasam, and C. W. Hogue Jr Atrial Fibrillation After Cardiac Surgery: Pathophysiology and Treatment Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2004; 8(3): 175 - 183. [Abstract] [PDF]
|
|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
