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J Thorac Cardiovasc Surg 2004;127:511-516
© 2004 The American Association for Thoracic Surgery

Cardiopulmonary support and physiology

Ventral cardiac denervation reduces the incidence of atrial fibrillation after coronary artery bypass grafting

^a Santa Cruz Hospital, Carnaxide, Portugal
^b Istanbul Memorial Hospital, Istanbul, Turkey
^c Leiden Universitair Medisch Center, Leiden, The Netherlands

Received for publication May 29, 2002; revisions received July 25, 2002; revisions received January 3, 2003; accepted for publication January 21, 2003.

^* Address for reprints: João Q. Melo, MD, PhD, Santa Cruz Hospital, Av. Prof. Reynaldo dos Santos, 2795-563 Carnaxide, Portugal
joaomelo100{at}hotmail.com

OBJECTIVES: Because the autonomic nervous system is an important determinant in the appearance of atrial fibrillation, we have assessed the role of ventral cardiac denervation for its prevention.

METHODS: Patients undergoing low-risk coronary artery surgery were enrolled. No routine antiarrhythmic drugs were administered before or after the operation. Ventral cardiac denervation was performed in 207 patients, and 219 patients were used as control subjects. Denervation was performed before cardiopulmonary bypass. The groups were comparable regarding demographic, clinical, and operative variables.

RESULTS: The additional time for the denervation was 5 ± 2 minutes, and there were no associated complications. Postoperative atrial fibrillation was present in 15 (7%) patients undergoing ventral cardiac denervation (95% confidence interval, 4%-12%) and in 56 (27%) control subjects (95% confidence interval, 18%-35%). Patients submitted to ventral cardiac denervation had fewer and less severe episodes of atrial fibrillation, and no patient had atrial fibrillation after discharge. Ventral cardiac denervation was the most significant predictor of postoperative atrial fibrillation (odds ratio, 0.42; confidence interval, 0.23-0.78; P = .006). Age of greater than 65 years (odds ratio, 1.67; confidence interval, 0.96-2.9; P = .067) was a highly suggestive predictor. The analysis of the effect of ventral cardiac denervation correlated with the patient's age showed a more pronounced effect in patients younger than 70 years (odds ratio, 0.43; confidence interval, 0.22-0.86; P = .022)

CONCLUSIONS: Ventral cardiac denervation is a fast and low-risk procedure. Its use significantly reduces the incidence and severity of atrial fibrillation after routine coronary artery bypass surgery. Patients younger than 70 years of age are expected to have a higher success rate than those older than 70 years.

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