To pace or not to pace: prevention of atrial fibrillation after coronary artery bypass surgery
Vora, Amit (2005) To pace or not to pace: prevention of atrial fibrillation after coronary artery bypass surgery. Indian Pacing and Electrophysiology Journal, 5 (1). pp. 1-4. ISSN 0972-6292
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Atrial fibrillation (AF) is a very undesirable, but unfortunately a common arrhythmia following coronary artery bypass graft (CABG) surgery, occurring in up to 40% of patients1. There is an increase in hospital stay2 and adds to the overall cost of the surgery. Atrial fibrillation occurrence may identify a subset of patients with reduced survival3. Prevention of AF therefore would have a significant positive impact on patients undergoing CABG surgery. The pathophysiology of post-operative AF is incompletely understood and appears multi-factorial. There are studies to suggest clinical factors like advanced age, prior history of AF4, post-operative withdrawal of beta-blocker or an angiotensin-converting enzyme (ACE) inhibitor, chronic obstructive lung disease predicting post-operative AF5. P-wave duration, increase in P wave dispersion6, postoperative low cardiac output, preoperative larger left atrium (LA) and LA appendage area, a lower LA ejection fraction, post-bypass atrial systolic dysfunction and abnormal relaxation of the left ventricle, higher preoperative heart rate, increased pulmonary capillary wedge pressure7, also predicts postoperative AF. It has been implicated that endogenously released adenosine has a role for triggering early (< 48 hr) post-CABG AF8. Another issue that received attention was the role of on-pump or off-pump bypass surgery, wherein no significant influence of either on the incidence of postoperative AF could be definitively established9. There are two opinions about the change in the autonomic tone brought about by dissection of the anterior epicardial fat or the aortic fat pad influencing the incid ence of post CABG AF10.
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