Abstract 16295: Human Epicardial Bipolar Electrograms Prolong and Reduce in Amplitude Prior to Induction of Peri-Operative Atrial Fibrillation and Are Related to Sites of High Electrogram Dominant Frequency in Sinus Rhythm

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Junaid Zaman ◽  
Leanne Harling ◽  
Thanos Athanasiou ◽  
Nicholas S Peters
Keyword(s):  
Sinus Rhythm ◽  
Artery Bypass ◽  
Dominant Frequency ◽  
Bypass Grafting ◽  
Activation Time ◽  
Frequency Domains ◽  
Cycle Lengths ◽  
Electrophysiological Findings ◽  
Atrial Activation ◽  
Right Atria

Background: The exact trigger/substrate interactions leading to post-operative AF are unknown. Sites of high DF in sinus rhythm are proposed to harbor ‘fibrillar myocardium’ or ‘AF nests’. We studied AF inducibility related to putative upstream substrate changes by characterising epicardial electrograms (EGM) in both time and frequency domains. Method: AF naïve patients (n=14) undergoing coronary artery bypass grafting (CABG) had bipolar electrograms recorded from the lateral right atria (RA) wall with a high density spiral catheter, sampled at 1kHz. RA burst pacing at cycle lengths (CL) of 200, 500 and 1000ms was performed with any episodes of AF > 30s recorded. Electrograms were analysed using an average of 5 consecutive beats for duration, peak to peak amplitude, dominant frequency (DF) and activation time at all bipole pairs during every pacing drive train (total EGMs analysed 3430). Results: Bipolar EGM duration was significantly longer during AF (mean = 76.64ms, SD = 29.35ms) than all other CLs or NSR (p<0.0001). There was no difference between CLs but a trend to longer EGM at 200ms CL. EGM amplitude was significantly smaller during AF (mean = 0.85mV, SD = 0.51mv) vs. 500ms CL and NSR (p<0.0001) and at 200ms vs. 500ms CL (p<0.05) and NSR (p<0.0001). The EGM DF was significantly lower in AF (mean = 75.87Hz, SD = 23.63Hz) vs NSR (mean = 89.33Hz, SD = 25.99Hz) (p<0.05) but not vs. pacing CLs. Activation time was significantly prolonged at 200ms CL (mean = 29.41ms, SD = 16.23ms) vs AF and NSR (p<0.001 and 0.05 respectively). Conclusions: Human bipolar EGMs prolong and reduce in amplitude in induced peri-operative AF than in NSR or pacing. Atrial activation slows at 200ms CL, prior to initiation of AF. These changes are accompanied by high DF sites in NSR which may reveal underlying ‘AF nests’ even in non-remodelled atria. These novel peri-operative electrophysiological findings suggest upstream substrate changes which may predispose patients to post-operative AF.

scholarly journals Postoperative Atrial Fibrillation and Long-Term Risk of Stroke After Isolated Coronary Artery Bypass Graft Surgery

Circulation ◽  
2020 ◽  
Vol 142 (14) ◽  
pp. 1320-1329
Author(s):  
Umberto Benedetto ◽  
Mario F. Gaudino ◽  
Arnaldo Dimagli ◽  
Stephen Gerry ◽  
Alastair Gray ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Sinus Rhythm ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Postoperative Atrial Fibrillation ◽  
Bypass Grafting ◽  
Artery Bypass Grafting

Background: Postoperative atrial fibrillation (pAF) after coronary artery bypass grafting is a common complication. Whether pAF is associated with an increased risk of cerebrovascular accident (CVA) remains uncertain. We investigated the association between pAF and long-term risk of CVA by performing a post hoc analysis of 10-year outcomes of the ART (Arterial Revascularization Trial). Methods: For the present analysis, among patients enrolled in the ART (n=3102), we excluded those who did not undergo surgery (n=25), had a history of atrial fibrillation (n=45), or had no information on the incidence of pAF (n=9). The final population consisted of 3023 patients, of whom 734 (24.3%) developed pAF with the remaining 2289 maintaining sinus rhythm. Competing risk and Cox regression analyses were used to investigate the association between pAF and the risk of CVA. Results: At 10 years, the cumulative incidence of CVA was 6.3% (4.6%–8.1%) versus 3.7% (2.9%–4.5%) in patients with pAF and sinus rhythm, respectively. pAF was an independent predictor of CVA at 10 years (hazard ratio, 1.53 [95% CI, 1.06–2.23]; P =0.025) even when CVAs that occurred during the index admission were excluded from the analysis (hazard ratio, 1.47 [95% 1.02–2.11]; P =0.04). Conclusions: Patients with pAF after coronary artery bypass grafting are at higher risk of CVA. These findings challenge the notion that pAF is a benign complication.

scholarly journals The left atrial appendage amputation during off-pump coronary artery bypass grafting prevents stroke

2021 ◽  
Author(s):  
Daisuke Endo ◽  
Tohru Asai ◽  
Taira Yamamoto ◽  
Atsumi Oishi ◽  
Yasutaka Yokoyama ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Artery Bypass ◽  
Atrial Appendage ◽  
Bypass Grafting ◽  
Off Pump ◽  
Pump Coronary Artery Bypass

Background: Postoperative atrial fibrillation (POAF) occurs in 20% to 50% of patients soon after cardiac surgery, and is associated with subsequent newly developed AF. Left atrial appendage closure is effective in preventing stroke among patients with nonvalvular AF. However, the prophylactic effect of left atrial appendage amputation (LAAA) in stroke prevention among patients with sinus rhythm has not been proven. Methods: We analyzed 977 consecutive patients undergoing off-pump coronary artery bypass grafting (OPCAB) with sinus rhythm, with or without concomitant LAAA, from 2011 to 2017 at our institution in a retrospective observational manner. A total of 550 patients (56.3%) underwent concomitant LAAA, any effect thereof in preventing early (<30 days) and later stroke was examined. Results: The incidences of POAF and early stroke were not significantly different between the groups. The incidence of later stroke was higher in patients without LAAA than in those with LAAA (4.0% vs. 1.6%; p = 0.02). In a subanalysis of patients without LAAA, stroke occurred more frequently in those with POAF than those without POAF (7.5% vs. 2.7%; p = 0.03), while in patients receiving LAAA, stroke incidences did not differ between those with and without POAF. Multivariate cox proportional hazard model showed POAF without LAAA was the only independent predictor of stroke (HR: 2.86; 95% CI: 1.10 to 7.45; p=0.03). Conclusions: Concomitant surgical LAA amputation during OPCAB reduces the risk of stroke.

scholarly journals Comparing efficacy of ibutilide and amiodarone for cardioversion in atrial fibrillation after coronary artery bypass grafting- A prospective and randomized study

2021 ◽  
Vol 8 (2) ◽  
pp. 167-171
Author(s):  
Mukesh Godara ◽  
Pradeep Kumar Goyal ◽  
Sonu Kumar Goyal ◽  
Dharmendra Carpenter
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Sinus Rhythm ◽  
Artery Bypass ◽  
P Value ◽  
Bypass Grafting ◽  
Group A ◽  
Group B ◽  
Cabg Patients

Ibutilideis less frequently used drug for atrial fibrillation (AF) in postoperative coronary artery bypass grafting (CABG) patients as compare to amiodarone. We therefore investigated the comparative efficacy of ibutilde and amiodarone for cardioversion in atrial fibrillation after CABG.To compare the efficacy of ibutilide and amiodarone for cardioversion of AF in post CABG patients. Narayana Multispeciality Hospital, Jaipur. Single center, randomized, double blind, comparative prospective study.Total 80 post CABG patients who developed AF were divided into two groups (Group A) Ibutilde and (Group B) Amiodarone respectively. The cardioversion time and cardioversion rate were measured. Unpaired t-test, Paired t-test, Chi square test / Fisher exact test. P value &#60;0.05 The cardioversion rate at 4hrs in group A was 42.5% and in group B was 50% (p value &#62; 0.001). At 24 hrs cardioversion rate in group A was 95% and in group B was 87.5% (p value &#62; 0.001). The mean time of conversion to sinus rhythm in group A was 382.85 minutes and in group B was 492.30 minutes. (p value= 0.235)Ibutilide was as effective as amiodarone for restoration of sinus rhythm in postoperative coronary bypass grafting patients who developed atrial fibrillation in their postoperative intensive care unit stay. Ibutilide may be superior to amiodarone in terms of hemodynamics and systemic side effects.

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