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J Thorac Cardiovasc Surg 2001;121:638-641
© 2001 The American Association for Thoracic Surgery

Editorials

Postoperative atrial fibrillation: An old problem crying for new solutions

From the Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Mo.

Received for publication Jan 9, 2001. Accepted for publication Jan 10, 2001. Address for reprints: Ralph J. Damiano, Jr, MD, John M. Shoenberg Professor of Surgery, Chief of Cardiac Surgery, Washington University School of Medicine, Campus Box 8234, Suite 3108 Queeny Tower, One Barnes-Jewish Hospital Plaza, St Louis, MO 63110.

For related article, see p. 683.

In this issue of the Journal, Mueller and colleagues ¹ report on their experience with postoperative atrial arrhythmias in a series of 183 patients who underwent isolated single coronary artery bypass grafting (CABG) with the left internal thoracic artery placed to the left anterior descending coronary artery. The authors observed that the prevalence of postoperative atrial arrhythmias was similar, at approximately 18% to 22%, for patients having conventional CABG and for those having beating-heart operations. With the development and growing acceptance of technologies that facilitate less invasive approaches for CABG, several recent, but conflicting, reports have been published on the frequency of this complication. ^2-12 In light of an appreciable change in the current practice of CABG, and the conflicting information regarding postoperative atrial fibrillation, it would be useful to reflect on what is presently known about this complication and the most appropriate direction for our future efforts in this area.

Large-scale longitudinal studies have demonstrated that atrial fibrillation is the most common arrhythmia in the general population. ^13,14 The prevalence of this arrhythmia increases with age, with a prevalence of less than 1% at age 50 but more than 9% to 10% at age 80. ¹³ Other risk factors in the general population include congestive heart failure, valvular heart disease, hypertension, diabetes, and a history of myocardial infarction. Given these predisposing factors, it is not surprising that this arrhythmia is a common complication in the adult population having cardiac surgery.

Atrial arrhythmias have been recognized as a common postoperative complication since the earliest days of CABG. These arrhythmias include atrial fibrillation, atrial flutter, and paroxysmal atrial tachycardia. Clinical studies have reported a prevalence of 25% to 40% among patients undergoing CABG, with a peak incidence occurring between the second and fourth days after the operation. ¹⁵ This rate . . . [Full Text of this Article]

Related Article

Did the introduction of a minimally invasive technique change the incidence of atrial fibrillation after single internal thoracic artery–left anterior descending artery grafting?

Xavier M. Mueller, Hendrik T. Tevaearai, Patrick Ruchat, Frank Stumpe, and Ludwig K. von Segesser
J. Thorac. Cardiovasc. Surg. 2001 121: 683-688. [Abstract] [Full Text] [PDF]

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