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J Thorac Cardiovasc Surg 2007;134:460-464
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Impact of high thoracic epidural anesthesia on incidence of perioperative atrial fibrillation in off-pump coronary bypass grafting: A prospective randomized study

^a Department of Thoracic & Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt/Main, Germany
^b Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Johann Wolfgang Goethe University Hospital, Frankfurt/Main, Germany
^c Department of Biomedical Statistics, Johann Wolfgang Goethe University Hospital, Frankfurt/Main, Germany
^d Department of Anesthesiology and Intensive Care Medicine, Friedrichsheim Foundation, Frankfurt/Main, Germany.

Received for publication February 22, 2007; revisions received March 15, 2007; accepted for publication March 29, 2007.

^_* Address for reprints: Farhad Bakhtiary, MD, Department of Thoracic & Cardiovascular Surgery, Johann Wolfgang Geothe University Hospital, Theodor-Stern-Kai 7, 60596 Frankfurt/Main, Germany. (Email: farhad{at}bakhtiary.de).

Objective: Atrial fibrillation is one of the most common complications in patients undergoing coronary artery bypass grafting. The goal of this study was to investigate the impact of high thoracic epidural anesthesia on reduction of perioperative arrhythmia in patients undergoing off-pump coronary artery bypass grafting.

Methods: We prospectively randomized 132 patients undergoing elective off-pump coronary bypass grafting using either general anesthesia (GA) (n = 66) or combined general and high thoracic epidural anesthesia (GA+TEA) (n = 66). Incidence of perioperative arrhythmias such as atrial fibrillation, serum epinephrine levels, heart rate variability, and hemodynamic parameters were compared between groups.

Results: The incidence of perioperative dysarrhythmias was significantly lower (P < .01) in the GA+TEA group (3%) than in the GA group (23.7%). Intraoperative sinus bradycardia occurred in 91% of the patients in the GA+TEA group versus 5.3% in the GA group. After induction of anesthesia, the mean systolic arterial pressure decreased significantly from 128 ± 5 to 92 ± 4 mm Hg and the heart rate from 74 ± 9 to 52 ± 8 beats · min^–1 in the GA+TEA group, whereas in the GA group no significant hemodynamic changes were observed (P < .001). Serum epinephrine levels were significantly lower in the GA+TEA group (69 ± 11 to 35 ± 7 ng/dL) than in the GA group (72 ± 9 to 70 ± 9 ng/dL).

Conclusions: In our study cohort, high thoracic epidural anesthesia in combination with general anesthesia reduced significantly the incidence of perioperative arrhythmias such as atrial fibrillation. Furthermore, we observed a significant reduction of epinephrine serum levels in this patient group. The results of this study support a combination of general anesthesia with thoracic epidural anesthesia as a multidisciplinary approach, which may lead to a better patient outcome, improvement of early analgesia, and reduction of perioperative complications in off-pump coronary artery bypass procedures. The potential risks of thoracic epidural anesthesia during off-pump coronary artery bypass procedures should not be underestimated.

This article has been cited by other articles:

				J. G.T. Augoustides Thoracic epidural anesthesia and atrial fibrillation after coronary bypass grafting. J. Thorac. Cardiovasc. Surg., February 1, 2008; 135(2): 466 - 467. [Full Text] [PDF]

				F. Bakhtiary, H. Ackermann, D. Meininger, P. Kleine, A. Moritz, and S. Dogan Reply to the Editor. J. Thorac. Cardiovasc. Surg., February 1, 2008; 135(2): 467 - 467. [Full Text] [PDF]