Atrial fibrillation after coronary bypass: etiology and pharmacologic prevention

Jayam, Vinod; Flaker, Gregory C.; Jones, Judy

doi:10.1016/s0967-2109(02)00023-6

Cited by 16 publications

(6 citation statements)

References 52 publications

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“…12 Although the rate-control strategy is preferred for patients in whom restoration of sinus rhythm is less important, most patients with new-onset postoperative AF are treated with antiarrhythmic therapy. 13 A recent prospective randomized study comparing primary rate control with conversion strategy in postoperative AF showed little difference in time to conversion between the 2 groups of patients. 9 This study also did not show a statistically significant reduction in the total length of stay through the conversion strategy, although the time from operation to discharge was significantly decreased.…”

Section: Discussionmentioning

confidence: 98%

When should we discontinue antiarrhythmic therapy for atrial fibrillation after coronary artery bypass grafting? A prospective randomized study

Izhar

Rudis

et al. 2005

The Journal of Thoracic and Cardiovascular Surgery

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Section: Discussionmentioning

confidence: 98%

When should we discontinue antiarrhythmic therapy for atrial fibrillation after coronary artery bypass grafting? A prospective randomized study

Izhar

Rudis

et al. 2005

The Journal of Thoracic and Cardiovascular Surgery

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“…38 Avoidance of cardiopulmonary bypass (CPB) is associated with reduced systemic inflammatory response 39 and decreased sympathetic tone. 40 The prevention of complement activation, release of cytokines, and endothelial activation is likely to be beneficial to other organs such as the lungs and kidneys, potentially resulting in better gas exchange and electrolyte balance. Global rather than regional ischemia has a detrimental effect on the atrial myocardium, causing alterations in atrial conduction and refractoriness resulting in the generation of arrhythmias.…”

Section: Discussionmentioning

confidence: 99%

Atrial Fibrillation, Blood Loss, and Transfusion in Patients With Left Ventricular Dysfunction

Jarral

Saso²,

Harling³

et al. 2012

ASAIO Journal

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Despite advancements in surgical technique, intensive care methods and pharmaceutical prophylaxis atrial fibrillation (AF) after on-pump coronary artery bypass remains common. Transfusion, blood loss, and cardiopulmonary bypass (CPB) have been identified as risk factors for AF and adverse outcomes such as early mortality. This study examines outcomes in patients with left ventricular dysfunction after revascularization with and without CPB. A systematic literature review identified 22 studies including 7,454 patients. Meta-analysis through subgroup analysis of the highest-quality studies revealed that the off-pump coronary artery bypass (OPCAB) technique is associated with a significantly lower incidence of blood loss, transfusion requirement, reoperation for bleeding, and length of stay. There was also a reduction in the incidence of AF in the OPCAB group but this was not statistically significant (odds ratio = 0.77, 95% confidence interval 0.58-1.02, p = 0.07). The results strengthen research suggesting that CPB has a damaging effect on hemostasis and subsequent transfusion requirements in this patient group. More research is required to assess the association between OPCAB and AF in patients with ventricular dysfunction.

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“…A recent meta-analysis (comprising largely low-risk patients) of 59 RCTs by Afilalo et al demonstrated a 30% relative risk reduction in stroke following OPCAB [16] and a similar analysis of 66 RCTs by Moller et al showed a 20% relative risk reduction in atrial fibrillation [12]. The institution of CPB is associated with a number of antiphysiological processes such as the generation of a significant inflammatory response [44,45]. The multiorgan benefits described above are likely to be secondary to avoidance of these processes.…”

Section: Organ Dysfunctionmentioning

confidence: 99%

Off-pump surgery: is it beneficial in patients with left ventricular dysfunction?

Jarral¹,

Athanasiou

2014

Expert Review of Cardiovascular Therapy

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On-pump coronary artery bypass surgery remains the gold standard for complex multivessel disease. Off-pump revascularization has matured as a technique over the last twenty years, but is used in less than 20% of cases worldwide. The poor uptake has been attributed to the significant learning curve in learning the procedure and conflicting evidence reports, together with concerns over mortality related conversion, graft patency and completeness of revascularization. Given these concerns, patient selection continues to be paramount and the subgroups that benefit most are hotly debated. Patients with left ventricular dysfunction constitute a high-risk subgroup which is enlarging in size. There is some evidence to suggest that avoidance of cardiopulmonary bypass in this group may lead to superior results in terms of early mortality, non-cardiac complications and organ dysfunction. Even with the theoretical risk of incomplete revascularization, the technique may be an attractive option in managing high-risk patients.

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Atrial fibrillation after coronary bypass: etiology and pharmacologic prevention

Cited by 16 publications

References 52 publications

When should we discontinue antiarrhythmic therapy for atrial fibrillation after coronary artery bypass grafting? A prospective randomized study

When should we discontinue antiarrhythmic therapy for atrial fibrillation after coronary artery bypass grafting? A prospective randomized study

Atrial Fibrillation, Blood Loss, and Transfusion in Patients With Left Ventricular Dysfunction

Off-pump surgery: is it beneficial in patients with left ventricular dysfunction?

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