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Preservation of the anterior fat pad paradoxically decreases the incidence of postoperative atrial fibrillation in humans

Jennifer E. Cummings, MD^*, Inderjit Gill, MD^*, Rami Akhrass, MD^*, MarkAlain Dery, MPH, DO^*, Lee A. Biblo, MD, FACC^* and Kara J. Quan, MD, FACC^*,*

^* 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

View larger version (110K): [in a new window]   Figure 1 Anterior surface of the human heart before coronary artery bypass surgery. Anterior fat pad demarcated. Ao = aorta; PA = pulmonary artery; RA = right atrium; RV = right ventricle.

View larger version (121K): [in a new window]   Figure 2 Custom-designed electrode applied to the anterior fat pad before coronary artery bypass surgery. Ao = aorta; PA = pulmonary artery; RA = right atrium; RV = right ventricle.

View larger version (121K): [in a new window]   Figure 3 Anterior surface of the heart after dissection of the anterior fat pad. Ao = aorta; PA = pulmonary artery; RA = right atrium.

View larger version (32K): [in a new window]   Figure 4 (a) Sinus cycle length (ms) at baseline and with nerve stimulation in all patients before coronary artery bypass grafting (CABG). Mean sinus cycle length (ms) with standard deviation at baseline and with nerve stimulation. (b) Sinus length (ms) at baseline and with nerve stimulation after CABG with anterior fat pad preservation. Mean sinus cycle length (ms) with standard deviation at baseline and with nerve stimulation. (c) Sinus cycle length (ms) at baseline and nerve stimulation after CABG with anterior fat pad dissection. Mean sinus cycle length (ms) with standard deviation at baseline and with nerve stimulation.

View larger version (108K): [in a new window]   Figure 5 Representative example of nerve stimulation effect. (Top panel) Lead II. Arrow depicts onset of nerve stimulation. Cycle length is shown in ms. Cycle length increases with nerve stimulation before fat pad dissection. (Middle panel) Lead II. Arrow depicts onset of nerve stimulation. Cycle length is shown in ms. Cycle length fails to increase with nerve stimulation after fat pad dissection. (Bottom panel) Lead II. This patient developed postoperative atrial fibrillation (AF) 48 h later.

View larger version (27K): [in a new window]   Figure 6 Incidence of postoperative atrial fibrillation in patients after coronary artery bypass grafting with anterior fat pad preservation and dissection.