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Jari Laurikka
Matti R. Tarkka
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Right arrow Cardiac - physiology

J Thorac Cardiovasc Surg 2003;126:1477-1482
© 2003 The American Association for Thoracic Surgery

Cardiopulmonary support and physiology

Fibrillation in patients subjected to coronary artery bypass grafting

Zhong-Kai Wu, MD, PhDa, Tiina Iivainen, MD, PhDb, Erkki Pehkonen, MD, PhDa, Jari Laurikka, MD, PhDa, Sijian Zhang, MD, MScc, Matti R. Tarkka, MD, PhDa,*

a Division of Cardiothoracic Surgery, Department of Surgery, Tampere University Hospital, Tampere, Finland
b Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
c Biostatistics and Bioinformatics Unit, Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Ala, USA

Received for publication August 1, 2002; revisions received September 6, 2002; accepted for publication January 23, 2003.

* Address for reprints: Matti R. Tarkka, MD, Division of Cardiothoracic Surgery, Department of Surgery, Tampere University Hospital, 33521, Tampere, Finland
matti.tarkka{at}tays.fi

OBJECTIVE: Atrial fibrillation is the most frequently encountered postoperative arrhythmic complication after coronary artery bypass grafting. Ischemic preconditioning has proved a potent endogenous factor in suppressing ischemia-reperfusion–induced arrhythmias. The protective effect of ischemic preconditioning on atrial fibrillation after coronary artery bypass grafting has not been studied. The purpose of the present study was to investigate whether ischemic preconditioning had an effect on postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting.

METHODS: Eighty-five patients undergoing coronary artery bypass grafting were randomized into ischemic preconditioning and control groups. Holter data from 24-hour electrocardiography were collected 1 day before the operation to the second postoperative day. Atrial fibrillation was registered as positive if any atrial fibrillation event occurred.

RESULTS: The overall incidence of postoperative atrial fibrillation and sustained atrial fibrillation was 34.1% and 27.1%, respectively. The occurrence of atrial fibrillation was significantly lower in the ischemic preconditioning group (21.4% in patients undergoing ischemic preconditioning and 46.5% in control subjects, P = .015). Preoperative recent unstable angina did not influence the incidence of atrial fibrillation. Patients with atrial fibrillation had longer intensive care unit stays and compromised postoperative hemodynamic outcomes. Binary logistic regression analysis showed that ischemic preconditioning, preoperative mean heart rate, and postoperative pulmonary capillary wedge pressure were the independent predictors of atrial fibrillation.

CONCLUSIONS: Postcoronary artery bypass grafting atrial fibrillation is associated with more complicated postoperative outcome. Higher preoperative heart rate and postoperative pulmonary capillary wedge pressure were the independent predictors of atrial fibrillation. Recent unstable angina is not related to the occurrence of postcoronary artery bypass grafting atrial fibrillation. Ischemic preconditioning significantly suppresses postcoronary artery bypass grafting atrial fibrillation, suggesting that ischemic preconditioning can be used as an effective prophylactic method for postoperative atrial fibrillation.




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