Short-term sinus rhythm predicts long-term sinus rhythm and clinical improvement after intraoperative ablation of atrial fibrillation. Effectiveness of Bi-atrial Pacing for Reducing Atrial Fibrillation after Coronary Artery Bypass Graft Surgery Preoperative atrial fibrillation is an independent risk factor for mid-term mortality after concomitant aortic valve replacement and coronary artery bypass graft surgery. Comparison of cardiac surgery with left atrial surgical ablation vs. cardiac surgery without atrial ablation in patients with coronary and/or valvular heart disease plus atrial fibrillation: final results of the PRAGUE-12 randomized multicentre study† Corticosteroids for the prevention of atrial fibrillation after cardiac surgery: a randomized controlled trial. Relation of an exaggerated rise in white blood cells after coronary bypass or cardiac valve surgery to development of atrial fibrillation postoperatively. Comparison of effectiveness of carvedilol versus metoprolol or atenolol for atrial fibrillation appearing after coronary artery bypass grafting or cardiac valve operation. Effect of dietary fish oil on atrial fibrillation after cardiac surgery. Statins improve surgical ablation outcomes for atrial fibrillation in patients undergoing concomitant cardiac surgery. Endoscopic Vascular Harvest in Coronary Artery Bypass Grafting Surgery: A Consensus Statement of the International Society of Minimally Invasive Cardiothoracic Surgery (ISMICS) 2005 The effects of atorvastatin on the occurrence of postoperative atrial fibrillation after off-pump coronary artery bypass grafting surgery. Left atrial radiofrequency ablation during cardiac surgery in patients with atrial fibrillation. Magnesium infusion dramatically decreases the incidence of atrial fibrillation after coronary artery bypass grafting. Omega-3 Fatty Acid Supplementation Does Not Reduce Risk of Atrial Fibrillation After Coronary Artery Bypass Surgery: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial Effective prevention of atrial fibrillation by continuous atrial overdrive pacing after coronary artery bypass surgery.
AIMS Our aim was to compare the long-term effects on rhythm and quality of life ( QoL ) after left atrial epicardial radiofrequency ( RF ) ablation vs. no ablation in patients undergoing cardiac surgery . METHODS AND RESULTS Thirty-nine patients with ECG documented atrial fibrillation ( AF ) scheduled for coronary artery bypass grafting ( CABG ) with or without concomitant valve surgery were consecutively elected for epicardial RF ablation .  Thirty-nine age- and gender-matched patients scheduled for CABG with or without concomitant valve surgery only and with documented AF served as controls . The follow-up after ablation was 32 + /- 11 months . The percentage of patients in sinus rhythm ( SR ) at long-term follow-up was 62 vs. 33 % ( P = 0.03 ) after ablation and no ablation , respectively . SR at 3 months was highly predictive of that at 32 months ( sensitivity 95 % , positive predictive value 86 % ) . Long-term SR was associated with better QoL , fewer symptoms , higher ejection fraction , and smaller left and right atria than AF . CONCLUSION SR at 3 months was highly predictive of long-term SR that was associated with clinical improvement when compared with patients still in AF . AF at 3 months did not preclude a later stabilization to SR Atrial fibrillation ( AF )  is common after cardiac surgery and adds significant cost and morbidity . The use of prophylactic pacing strategies to prevent post-operative AF has been controversial . We previously performed a pilot study which suggested that the combination of beta-blockers and bi-atrial pacing ( BAP ) may reduce AF after cardiac surgery . We prospect ively r and omized 118 patients to continuous BAP for up to 96 hours post-operatively versus st and ard therapy .  All patients were treated with beta-blockers as tolerated . Patients were paced in the AAI mode at a rate of 100 pulses per minute . The primary endpoint of the study was the occurrence of sustained AF ( > 10 minutes).There was a significant reduction in the incidence of AF in the BAP group among patients undergoing coronary artery bypass graft surgery with or without aortic valve replacement ( 35 % vs. 19 % AF ; OR=0.38 , 95 % CI 0.15 , 0.93 ; p < 0.05 ) . Including patients undergoing isolated aortic valve surgery ( n=7 ) , there remained a strong trend toward a reduction of AF with pacing ( no atrial pacing [ NAP ] vs. BAP ; 35 % vs. 21 % AF ; OR=0.48 , 95 % CI 0.21 , 1.11 ; p=0.08 ) . Patients age 70 or greater benefited most from pacing ( NAP vs. BAP ; 55 vs. 25 % AF ; p<0.05 ) , while those less than 70 years of age did not ( 17 vs. 18 % p = NS ) . There was a significant reduction in the amount of time spent in the intensive care unit among patients receiving BAP ( 50±40 vs. 37±25[emsp4 ] h ; p<0.05).BAP together with beta-blockade after coronary artery bypass graft surgery reduces the incidence of post-operative atrial AF .  Elderly patients ( age 70 or greater ) appear to benefit most , and may be a group to whom this therapy should be targeted OBJECTIVES Preoperative atrial fibrillation ( PAF )  has been associated with poorer early and mid-term outcomes after isolated valvular or coronary artery bypass graft surgery . Few studies , however , have evaluated the impact of PAF on early and mid-term outcomes after  concomitant aortic valve replacement and coronary aortic bypass graft ( AVR-CABG ) surgery . METHODS Data obtained prospect ively between June 2001 and December 2009 by the Australian and New Zeal and Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Data base Program was retrospectively analysed . Patients who underwent concomitant atrial arrhythmia surgery/ablation were excluded . Demographic and operative data were compared between patients undergoing concomitant AVR-CABG  who presented with PAF and those who did not using chi-square and t-tests . The independent impact of PAF on 12 short-term complications and mid-term mortality was determined using binary logistic and Cox regression , respectively . RESULTS Concomitant AVR-CABG surgery was performed in 2563 patients ; 322 ( 12.6 % ) presented with PAF . PAF patients were generally older ( mean age 76 vs 74 years ; P < 0.001 ) and presented more often with comorbidities including congestive heart failure , chronic pulmonary disease and cerebrovascular disease ( all P < 0.05 ) . PAF was associated with 30-day mortality on univariate analysis ( P = 0.019 ) but not multivariate analysis ( P = 0.53 ) . The incidence of early complications was not significantly higher in the PAF group . PAF was independently associated with reduced mid-term survival ( HR , 1.58 ; 95 % CI , 1.14 - 2.19 ; P = 0.006 ) . CONCLUSIONS PAF is associated with reduced mid-term survival after concomitant AVR-CABG surgery .  Patients with PAF undergoing AVR-CABG  should be considered for a concomitant surgical ablation procedure Aims Surgical ablation procedure can restore sinus rhythm ( SR ) in patients with atrial fibrillation ( AF ) undergoing cardiac surgery . However , it is not known whether it has any impact on long-term clinical outcomes . Methods and results This multicentre study r and omized 224 patients with AF scheduled for valve and /or coronary surgery : group A  ( left atrial surgical ablation , n = 117 ) vs. group B  ( no ablation , n = 107 ) . The primary efficacy outcome was the SR presence ( without any AF episode ) during a 24 h electrocardiogram ( ECG )  after 1 year . The primary safety outcome was the combined endpoint of death/myocardial infa rct ion/stroke/renal failure at 30 days . A Holter-ECG after 1 year revealed SR in 60.2 % of group A patients vs. 35.5 % in group B ( P = 0.002 ) . The combined safety endpoint at 30 days occurred in 10.3 % ( group A ) vs. 14.7 % ( group B , P = 0.411 ) . All-cause 1-year mortality was 16.2 % ( A ) vs. 17.4 % ( B , P = 0.800 ) . Stroke occurred in 2.7 % ( A ) vs. 4.3 % ( B ) patients ( P = 0.319 ) . No difference ( A vs. B ) in SR was found among patients with paroxysmal ( 61.9 vs. 58.3 % ) or persistent ( 72 vs. 50 % ) AF , but ablation significantly increased SR prevalence in patients with longst and ing persistent AF ( 53.2 vs. 13.9 % , P < 0.001 ) . Conclusion Surgical ablation improves the likelihood of SR presence post-operatively without increasing peri-operative complications . However , the higher prevalence of SR did not translate to improved clinical outcomes at 1 year . Further follow-ups ( e.g. 5-year ) are warranted to show any potential clinical benefit which might occur later CONTEXT Atrial fibrillation ( AF ) is the most common arrhythmia to occur after cardiac surgery . An exaggerated inflammatory response has been proposed to be one etiological factor . OBJECTIVE To test whether intravenous corticosteroid administration after cardiac surgery prevents AF after cardiac surgery . DESIGN , SETTING , AND PATIENTS A double-blind , r and omized multicenter trial ( study enrollment August 2005-June 2006 ) in 3 university hospitals in Finl and of 241 consecutive patients without prior AF or flutter and scheduled to undergo first on-pump coronary artery bypass graft ( CABG ) surgery , aortic valve replacement , or combined CABG surgery and aortic valve replacement . INTERVENTION Patients were r and omized to receive either 100-mg hydrocortisone or matching placebo as follows : the first dose in the evening of the operative day , then 1 dose every 8 hours during the next 3 days . In addition , all patients received oral metoprolol ( 50 - 150 mg/d ) titrated to heart rate . MAIN OUTCOME MEASURE Occurrence of AF during the first 84 hours after cardiac surgery . RESULTS The incidence of postoperative AF was significantly lower in the hydrocortisone group ( 36/120 [ 30 % ] ) than in the placebo group ( 58/121 [ 48 % ] ; adjusted hazard ratio , 0.54 ; 95 % confidence interval , 0.35 - 0.83 ; P = .004 ; number needed to treat , 5.6 ) . Compared with placebo , patients receiving hydrocortisone did not have higher rates of superficial or deep wound infections , or other major complications . CONCLUSION Intravenous hydrocortisone reduced the incidence of AF after cardiac surgery . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00442494 This study investigated the correlation between an elevated white blood cell ( WBC ) count as a marker of inflammation and the development of  atrial fibrillation ( AF ) after cardiac surgery .  WBC counts  were prospect ively followed in 181 consecutive patients who underwent coronary bypass or cardiac valve surgery  to determine if a baseline or postoperative WBC count elevation is an independent predictor of postoperative AF A retrospective review of 115 patients who underwent cardiac surgery demonstrated a marked reduction in postoperative atrial fibrillation ( 8 % vs 32 % , p < 0.05 ) in patients who received carvedilol versus metoprolol or atenolol immediately after surgery . A prospect i ve study examining the possibility of carvedilol 's greater efficacy in preventing postoperative atrial fibrillation appears warranted An open-label study reported that ingestion of a fish oil concentrate decreased the incidence of  atrial fibrillation ( AF ) after coronary artery bypass grafting ( CABG ) surgery . However , a general cardiac surgery population involves valve and CABG surgeries . We undertook a double-blinded r and omized controlled trial to examine the effectiveness of fish oil supplementation on the incidence of  postsurgical AF after CABG and valve procedures . The primary end point was incidence of AF in the first 6 days after surgery . Two hundred patients were r and omized to receive fish oil ( providing 4.6 g/day of long-chain ω-3 fatty acids ) or a control oil starting 3 weeks before surgery ; 194 subjects completed the study , with 47 of 97 subjects in the control group and 36 of 97 subjects in the fish oil group developing AF ( odds ratio 0.63 , 95 % confidence interval [ CI ] 0.35 to 1.11 ) . There was a nonstatistically significant delay in time to onset of AF in the fish oil group ( hazard ratio 0.66 , 95 % CI 0.43 to 1.01 ) . There was a significant decrease in mean length of stay in the intensive care unit in the fish oil group ( ratio of means 0.71 , 95 % CI 0.56 to 0.90 ) . In conclusion , in a mixed cardiac surgery population , supplementation with dietary fish oil did not result in a significant decrease in the incidence of postsurgical AF . However , there was a significant decrease in time spent in the intensive care unit Ablation outcomes were investigated in patients with and without statin pretreatment before cardiac surgery with concomitant surgical ablation for atrial fibrillation ( AF ) . A prospect i ve cohort study was performed containing 149 patients ( n=73 statin group vs. n=76 control group ) undergoing on-pump cardiac procedures with surgical ablation for paroxysmal or persistent AF . Measured outcomes were freedom from AF in the intensive care unit , discharge and at three and six months follow-up and perioperative markers of inflammation ( white blood cell count , C-reactive protein ) . Independent predictors for freedom from AF were assessed . Groups did not differ with respect to EuroSCORE , New York Heart Association class , left atrial size , anti-arrhythmic drug therapy or aortic cross-clamp time . Statin therapy had no impact on postoperative inflammatory markers . Freedom from AF was more frequent in the statin group at discharge ( P=0.07 ) and after three and six months ( P<0.05 ) . Subgroup analysis showed that statin pretreatment was associated with higher rates of freedom from AF for paroxysmal AF at three and six months and for persistent AF after six months ( P<0.05 ) . Importantly , statin-pretreatment was independently predictive for freedom from AF at discharge [ odds ratio ( OR ) : 3.21 ; 95 % confidence interval ( CI ) : 1.2 - 8.55 ; P=0.02 ] and at three months ( OR : 2.91 ; 95 % CI : 1.14 - 7.45 ; P=0.026 ) . Statin therapy prior to ablation surgery improves postoperative freedom from AF for paroxysmal and persistent AF in cardiac surgery patients Objective This purpose of this consensus statement was to compare endoscopic vascular graft harvesting ( EVH ) with conventional open vascular harvesting ( OVH ) in adults undergoing coronary artery bypass grafting ( CABG ) surgery and to determine which result ed in improved clinical and re source outcomes . Methods Before the consensus conference , the consensus panel review ed the best available evidence , whereby systematic review s , r and omized trials , and nonr and omized trials were considered in descending order of importance . Evidence -based statements were created , and consensus processes were used to determine the ensuing statements . The AHA/ACC system was used to label the level of evidence and class of recommendation . Results The consensus panel agreed upon the following statements : 1 . EVH is recommended to reduce wound related complications when compared with OVH ( Class I , Level A ) . 2 . Based on quality of conduit harvested , either endoscopic or open vein harvest technique may be used ( Class IIa ; Level B ) . 3 . Based on major adverse cardiac events and angiographic patency at 6 months , either endoscopic or open vein harvest technique may be used ( Class IIa ; Level A ) . 4 . EVH is recommended for vein harvesting to improve patient satisfaction and postoperative pain when compared with OVH in CABG surgery ( Class I , Level A ) . 5 . EVH is recommended for vein harvesting to reduce postoperative length of stay and outpatient wound management re sources ( Class I , Level A ) . Conclusions Given these evidence -based statements , the consensus panel stated that EVH should be the st and ard of care for patients who require saphenous vein grafts for coronary revascularization ( Class I , Level B ) . Future research should address long-term safety , cost-effectiveness , and endoarterial harvest BACKGROUND  Atrial fibrillation ( AF ) after coronary artery bypass graft ( CABG ) surgery is still the most common arrhythmic complication . This study evaluated whether pretreatment with atorvastatin protects against AF after off-pump CABG . METHODS One hundred twenty-four patients without a history of AF or previous statin use , who were scheduled to undergo elective off-pump CABG , were enrolled . Patients were r and omized to control group ( n = 62 ) or to atorvastatin group ( n = 62 ) who were administered  atorvastatin 20 mg/d for 3 days before the surgery . Primary outcome was the incidence of postoperative AF . Secondary outcomes were major adverse cardiac and cerebrovascular events , persistent AF at 1 month , and identification of the markers to predict inhospital postoperative AF . RESULTS The incidence of AF was significantly lower in the atorvastatin group than in the control group ( 13 % vs 27 % , P = .04 ) . The incidence of major adverse cardiac and cerebrovascular events and persistent AF at 1 month was similar in comparisons between the groups . Postoperative peak N-terminal pro-brain natriuretic peptide levels were significantly higher in the patients with AF ( P = .03 ) . Multivariate analysis identified pretreatment with atorvastatin as an independent factor associated with a significant reduction in postoperative AF ( odds ratio 0.34 , P = .04 ) . Higher postoperative peak N-terminus pro-B-type natriuretic peptide levels were associated with the development of postoperative AF ( odds ratio 1.02 per 100 pg/mL , P = .03 ) . CONCLUSIONS Pretreatment with atorvastatin significantly reduced the occurrence of postoperative AF after off-pump CABG INTRODUCTION Intraoperative left atrial radiofrequency ( RF ) ablation recently has been suggested as an effective surgical treatment for atrial fibrillation ( AF ) . The aim of this study was to verify the outcome of this technique in a controlled multicenter trial . METHODS AND RESULTS One hundred three consecutive patients ( 39 men and 65 women ; age 62 + /- 11 years ) affected by AF underwent cardiac surgery and RF ablation in the left atrium ( RF group ) . The control group consisted of 27 patients ( 6 men and 21 women ; age 64 + /- 7 years ) with AF who underwent cardiac surgery during the same period and refused RF ablation .  Mitral valve disease was present in 89 ( 86 % ) and 25 ( 92 % ) patients , respectively ( P = NS ) . RF endocardial ablation was performed in order to obtain isolation of both right and left pulmonary veins , a lesion connecting the previous lines , and a lesion connecting the line encircling the left veins to the mitral annulus . Upon discharge from the hospital , sinus rhythm was present in 65 patients ( 63 % ) versus 5 patients ( 18 % ) in the control group ( P < 0.0001 ) . Mean time of cardiopulmonary bypass was longer in the RF group ( 148 + /- 50 min vs 117 + /- 30 min , P = 0.013 ) . The complication rate was similar in both groups , but RF ablation-related complications occurred in 4 RF group patients ( 3.9 % ) . After a mean follow-up of 12.5 + /- 5 months ( range 4 - 24 ) , 83 ( 81 % ) of 102 RF group patients were in stable sinus rhythm versus 3 ( 11 % ) of 27 in the control group ( P < 0.0001 ) . The success rate was similar among the four surgical centers . Atrial contraction was present in 66 ( 79.5 % ) of 83 patients in the RF group in sinus rhythm . CONCLUSION Endocardial RF left atrial compartmentalization during cardiac surgery is effective in restoring sinus rhythm in many patients . This technique is easy to perform and reproducible . Rare RF ablation-related complications can occur . During follow-up , sinus rhythm persistence is good , and biatrial contraction is preserved in most patients BACKGROUND  Atrial fibrillation ( AF )  is one of the most common complications of cardiac surgery . Magnesium , like several other pharmacologic agents , has been used in the prophylaxis of postoperative AF with varying degrees of success . However , the dose and the timing of magnesium prophylaxis need to be clarified . The purpose of this study was to assess the effect of intermittent magnesium infusion on postoperative AF . METHODS A total of 200 consecutive patients who had elective , isolated , first-time coronary artery bypass grafting were prospect ively r and omized to two groups . Patients in the magnesium group ( n = 100 ) received 6 mmol MgSO4 infusion in 100 mL 0.9 % NaCl solution ( 25 mL/h ) the day before surgery , just after cardiopulmonary bypass , and once daily for 4 days after surgery . Patients in the control group ( n = 100 ) received only 100 mL 0.9 % NaCl solution ( 25 mL/h ) at the same time points . RESULTS Postoperative AF occurred in 2 ( 2 % ) patients in the magnesium group and in 21 ( 21 % ) patients in the control group ( p < 0.001 ) . Atrial fibrillation started , on average , 49.4 + /- 16.8 hours postoperatively . The postoperative length of hospital stay was not significantly different in patients with AF ( 7.4 + /- 8.0 days ) compared with patients without AF ( 5.4 + /- 1.1 days ; p = 0.236 ) . CONCLUSIONS The use of magnesium in the preoperative and early postoperative periods is highly effective in reducing the incidence of AF after coronary artery bypass grafting Background —Omega-3 polyunsaturated fatty acids ( n-3 PUFA ) have been reported to reduce the risk of sudden cardiac death presumed to be due to fatal ventricular arrhythmias , but their effect on atrial arrhythmias is unclear . Methods and Results — Patients ( n=108 ) undergoing coronary artery bypass graft surgery were r and omly assigned to receive 2 g/d n-3 PUFA or placebo ( olive oil ) for at least 5 days before surgery ( median , 16 days ; range , 12 to 21 days ) . Phospholipid n-3 PUFA were measured in serum at study entry and at surgery and in right atrial appendage tissue at surgery . Echocardiography was used to assess left ventricular function and left atrial dimensions .  Postoperative continuous ECG monitoring ( Lifecard CF ) for 5 days or until discharge , if earlier , was performed with a daily 12-lead ECG and clinical review if patients remained in the hospital beyond 5 days . Lifecard recordings were analyzed for episodes of atrial fibrillation ( AF ) ≥30 seconds ( primary outcome ) . Clinical AF , AF burden ( % time in AF ) , hospital stay , and intensive care/high dependency care stay were measured as secondary outcomes . One hundred three patients completed the study ( 51 in the placebo group and 52 in the n-3 PUFA group ) . There were no clinical ly relevant differences in baseline characteristics between groups . n-3 PUFA levels were higher in serum and right atrial tissue in the active treatment group . There was no significant difference between groups in the primary outcome of AF ( 95 % confidence interval [ CI ] , −6 % to 30 % , P=0.28 ) in any of the secondary outcomes or in AF-free survival . Conclusions —Omega-3 PUFA do not reduce the risk of AF after coronary artery bypass graft surgery . Clinical Trial Registration —www.ukcrn.org.uk . Identifier : 4437 OBJECTIVES The present study was aim ed to evaluate the efficacy of a specific algorithm with continuous atrial dynamic overdrive pacing to prevent atrial fibrillation ( AF ) after coronary artery bypass graft ( CABG ) surgery . BACKGROUND Atrial fibrillation occurs in 30 % to 40 % of patients after cardiac surgery with a peak incidence on the second day . It still represents a challenge for postoperative prevention and treatment and may have medical and cost implication s. METHODS Ninety-six consecutive patients undergoing CABG for severe coronary artery disease and in sinus rhythm without antiarrhythmic therapy on the second postoperative day were r and omized to have or not 24 h of atrial pacing through temporary epicardial wires using a permanent dynamic overdrive algorithm .  Holter ECGs recorded the same day in both groups were analyzed to detect AF occurrence . RESULTS No difference was observed in baseline data between the two study groups , particularly for age , male gender , history of AF , ventricular function , severity of coronary artery disease , preoperative beta-adrenergic blocking agent therapy or P-wave duration . The incidence of AF was significantly lower ( p = 0.036 ) in the paced group ( 10 % ) compared with control subjects ( 27 % ) . Multivariate analysis showed AF incidence to increase with age ( p = 0.051 ) but not in patients with pacing ( p = 0.078 ) . It decreased with a better left ventricular ejection fraction only in conjunction with atrial pacing ( p = 0.018 ) . CONCLUSIONS We conclude that continuous atrial pacing with an algorithm for dynamic overdrive reduces significantly incidence of AF the second day after CABG surgery , particularly in patients with preserved left ventricular function
Results The consensus panel agreed on the following statements in patients with AF undergoing cardiac surgery concomitant surgical ablation : 1 .
Improves the achievement of sinus rhythm at discharge and 1 year ( level A ) ; this effect is sustained up to 5 years ( level B ) .
2 .
3 .
Does not increase the risk of perioperative mortality ( level A ) , stroke ( level A ) , myocardial infa rct ion ( level B ) , cardiac tamponade ( level A ) , reoperative bleeding ( level A ) , esophageal injury ( level B ) , low cardiac output ( level A ) , intraaortic balloon ( level B ) , congestive heart failure ( level B ) , ejection fraction ( EF ; level B ) , pleural effusion ( level A ) , pneumonia ( level A ) , renal dysfunction ( level B ) , and mediastinitis ( level A ) .
The incidence of esophageal injury remains to be low ( level B ) .
4 .
Does not reduce mortality at 1 year ( level A ) .
5 .
6 .
Increases cardiopulmonary bypass and cross-clamp times ( level A ) , with no difference in intensive care unit and hospital length of stay ( level A ) .
Conclusions Given these evidence -based statements , the consensus panel stated that , in patients with persistent and permanent AF undergoing cardiac surgery , concomitant surgical ablation is recommended to increase incidence of sinus rhythm at short- and long-term follow-up ( class 1 , level A ) ; to reduce the risk of stroke and thromboembolic events ( class 2a , level B ) ; to improve EF ( class 2a , level A ) ; and to exercise tolerance ( class 2a , level A ) and long-term survival ( class 2a , level B )
Objective This purpose of this consensus conference was to determine whether surgical atrial fibrillation ( AF ) ablation during cardiac surgery improves clinical and re source outcomes compared with cardiac surgery alone in adults undergoing cardiac surgery for valve or coronary artery bypass grafting .