scholarly journals Radiofrequency pulmonary vein isolation for the prevention of new-onset atrial fibrillation after coronary artery bypass grafting

2020 ◽  
Vol 24 (3) ◽  
pp. 80
Author(s):  
A. Sh. Revishvili ◽  
V. A. Popov ◽  
E. S. Malyshenko ◽  
G. P. Plotnikov ◽  
M. M. Anishchenko ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Radiofrequency Ablation ◽  
Coronary Artery Bypass ◽  
Pulmonary Vein ◽  
Conflict Of Interest ◽  
Artery Bypass ◽  
Group I ◽  
New Onset

<p><strong>Aim.</strong> To evaluate the in-hospital results of the epicardial bipolar radiofrequency ablation of the pulmonary vein in the<br />prevention of new-onset postoperative atrial fibrillation (POAF) in coronary artery disease (CAD) patients undergoing coronary artery bypass graft (CABG) surgery in a pilot randomised multi-centre controlled Pulmonary Vein Ablation (PULVAB).</p><p><strong>Methods.</strong> The pilot study was conducted for the organisation of a multi-centre randomised PULVAB trial. We enrolled 63 CAD patients without a history of AF. The inclusion criterion was CAD demanding CABG; the exclusion criteria were as follows: AF history, antiarrhythmic therapy in anamnesis, significant heart valve disease, severe renal failure and decompensating diabetes mellitus. The patients were randomised into 2 groups. Group I comprised 34 patients who underwent CABG alone, and Group II had 29 patients who underwent CABG combined with radiofrequency ablation (RFA) as the initial tool for POAF prevention. All the procedures were performed by a single surgical team using standardised anaesthetic and perfusion support.</p><p><strong>Results.</strong> There was no in-hospital mortality in either group. There were differences in the duration of the intervention,<br />cardiopulmonary bypass time and the aorta clamping time between groups (p &gt; 0.05). A higher incidence of POAF was<br />observed (11 %–32.4 %) in the isolated CABG group than in the CABG combined with PULVAB group (6 %–20.7 %), although the difference was not significant (p = 0.29). In most cases (91 %), AF occurred on the second to third postoperative day, irrespective of the observation group.</p><p><strong>Conclusion.</strong> The combination of CABG and RFA does not complicate the operation and does not increase the duration of the surgery or time of cardiopulmonary bypass. There were no significant differences in the postoperative course or the incidence and structure of complications between the groups. This may indicate the safety of our method. The positive tendency of POAF-cases decrease after preventive epicardial RFA observed in the present study allows us to continue the PULVAB study to gain more statistically significant results.</p><p><strong>Clin.Trials.gov Identifier:</strong> NCT03857711</p><p>Received 20 February 2020. Revised 29 June 2020. Accepted 2 July 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and design: A.Sh. Revishvili, V.A. Popov<br />Data collection and analysis: M.M. Anishchenko, E.S. Malyshenko, N.V. Popova<br />Statistical analysis: M.M. Anishchenko<br />Drafting the article: G.P. Plotnikov, M.M. Anishchenko<br />Critical revision of the article: A.Sh. Revishvili, V.A. Popov<br />Final approval of the version to be published: A.Sh. Revishvili, V.A. Popov, E.S. Malyshenko, G.P. Plotnikov, M.M. Anishchenko, N.V. Popova</p>

scholarly journals Assessment of Bipolar Radiofrequency Ablation Combined with Coronary Artery Bypass Surgery for Management of Atrial Fibrillation in Cardiac Patients

2020 ◽  
Vol 23 (6) ◽  
pp. E826-E832
Author(s):  
Hamdy Singab
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Radiofrequency Ablation ◽  
Sinus Rhythm ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Nyha Class ◽  
Bipolar Radiofrequency ◽  
Group I ◽  
Group Ii

Background: Atrial fibrillation (AF) is a common problem in patients undergoing coronary artery bypass graft (CABG). For AF ablation, bipolar radiofrequency ablation (BRA) achieves complete transmural ablation lines and reduces the risk of treatment failure. We analyzed the efficacy of BRA for sinus rhythm restoration in patients with AF undergoing CABG. Methods: This prospective study included patients with permanent or paroxysmal AF scheduled to undergo BRA combined with CABG in our institution from May 2014 to June 2020. After discharge from hospital, all patients were seen every 6 months over 5 years to evaluate survival, sinus rhythm restoration, and New York Heart Association (NYHA) class. Results: We enrolled 168 patients, 97 (57.7%) with permanent AF (group I) and 71 (42.3%) with paroxysmal AF (group II) at 60 months. We found that group II patients had better sinus rhythm restoration rates after BRA with CABG than group I patients (P = .005). Overall mortality at 60 months was significantly lower in group II patients (2 [2.8%]) than patients in group I (14 [14.4%]; P = .01). The survival rate was significantly higher in group II than in group I (94% versus 72%; P = .0003) as shown by Kaplan–Meier analysis. The 95% confidence interval of the Cox hazards survival regression ratio was significantly different between groups (0.1792 [0.04069 to 0.7896]; P = .006). Long-term AF (>3 years) before BRA with CABG and permanent AF type were identified as predictors of post-BRA recurrent AF (P = .0001 and P = .005, respectively). NYHA class improved significantly at 60 months compared with baseline (P < .0001). Conclusions: This study identified preoperative AF type and duration as predictors of the success of BRA combined with CABG.

Use of Intraoperative Transesophageal Echocardiography to Predict Atrial Fibrillation after Coronary Artery Bypass Grafting

2001 ◽  
Vol 95 (3) ◽  
pp. 652-658 ◽  
Author(s):  
Linda Shore-Lesserson ◽  
David Moskowitz ◽  
Craig Hametz ◽  
David Andrews ◽  
Tatsuya Yamada ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Transesophageal Echocardiography ◽  
Coronary Artery Bypass ◽  
Pulmonary Vein ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Artery Bypass ◽  
Velocity Ratio

Background Postoperative atrial fibrillation in coronary artery bypass graft surgery occurs in 10-40% of patients. It is associated with a significant degree of morbidity and results in prolonged lengths of stay in both the intensive care unit and hospital. Methods The authors prospectively evaluated patients undergoing coronary artery bypass with detailed transesophageal echocardiography examinations conducted before and after cardiopulmonary bypass to study whether risk factors for atrial fibrillation could be identified. Demographic and surgical parameters were also included in the analysis. Selected variables were subjected to univariate and subsequent multivariate analyses to test for their independent or joint influence on atrial fibrillation. Results Seventy-nine patients had assessable transesophageal echocardiography examinations. Significant univariate predictors of atrial fibrillation included advanced age (P = 0.002), pre-cardiopulmonary bypass left atrial appendage area (P = 0.04), and post-cardiopulmonary bypass left upper pulmonary vein systole/diastole velocity ratio (P = 0.03). When these three factors were considered together in a multiple logistic regression analysis, left upper pulmonary vein systole/diastole velocity ratio was a significant predictor (P &lt; 0.05), as was the joint effect of age plus pre-cardiopulmonary bypass left atrial appendage area (P = 0.005). The probability of developing atrial fibrillation for the combination of age = 75 yr, post-cardiopulmonary bypass left upper pulmonary vein systole/diastole velocity ratio = 0.5, and left atrial appendage area = 4.0 cm was 0.83 (95% confidence interval, 0.51-0.96). Conclusions Early identification of patients at risk for postoperative atrial fibrillation may be feasible using the parameters identified in this study.

scholarly journals Resource Utilization Related to Atrial Fibrillation After Coronary Artery Bypass Grafting

2002 ◽  
Vol 11 (3) ◽  
pp. 228-238 ◽  
Author(s):  
Marilyn Hravnak ◽  
Leslie A. Hoffman ◽  
Melissa I. Saul ◽  
Thomas G. Zullo ◽  
Gayle R. Whitman
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Resource Utilization ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Onset Atrial Fibrillation ◽  
New Onset

• Background Studies of resource utilization by patients with new-onset atrial fibrillation after coronary artery bypass grafting have addressed only length of stay and bed charges.• Objective To compare resource utilization between patients with new-onset atrial fibrillation and patients without atrial fibrillation after isolated coronary artery bypass grafting.• Methods Retrospective review of clinical and administrative electronic databases for 720 subjects who underwent isolated coronary artery bypass grafting with cardiopulmonary bypass in 25 months at one medical center. The prevalence of atrial fibrillation was determined, and resource utilization in various hospital cost centers was compared between subjects with and without atrial fibrillation.• Results The prevalence of new-onset atrial fibrillation was 33.1%. Compared with subjects without atrial fibrillation, subjects with atrial fibrillation had a longer stay (5.8 ± 2.4 vs 4.4 ± 1.2 days, P&lt; .001), more days receiving mechanical ventilation (P=.002) and oxygen therapy (P&lt; .001), and higher rates of readmission to the intensive care unit (4.6% vs 0.2%, P&lt; .001). Subjects with atrial fibrillation also had more laboratory tests (P&lt; .001) and more days receiving cardiac drugs, heparin, diuretics, and electrolytes. Subjects with atrial fibrillation had higher total postoperative charges ($57261 ± $17 101 vs $50 905 ± $10 062, P = .001), a mean difference of $6356. The mean differences were greatest for bed charges ($1642), laboratory charges ($1215), pharmacy ($989), and respiratory care ($582).• Conclusions The economic impact of atrial fibrillation after coronary artery bypass grafting has been underestimated.

scholarly journals Effect of preoperative atrial fibrillation on long-term results after Off Pump Coronary Artery Bypass

2021 ◽  
Vol 38 (6) ◽  
pp. 5-15
Author(s):  
Soslan T. Enginoev ◽  
Dmitriy A. Kondratiev ◽  
Gasan M. Magomedov ◽  
Tamara K. Rashidova ◽  
Bakytbek K. Kadyraliev ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Sinus Rhythm ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Long Term Results ◽  
Off Pump ◽  
Group I ◽  
Pump Coronary Artery Bypass

Objective. To study the effect of preoperative atrial fibrillation (AF) on the risk of stroke and long-term mortality after Off Pump Coronary Artery Bypass (OPCAB). Materials and methods. A retrospective analysis of the results of OPCAB in 212 patients with coronary artery disease (CAD), who were operated on from May 2009 to November 2013, was carried out. After propensity score matching, patients were divided into 2 groups: Group I 82 patients with sinus rhythm (SR) before surgery, Group II (control) 102 patients with AF before surgery. The average age of the included patients was 61 6.7 years, with 95 % CI: 6062. Fifty-four (29.3 %) patients were over 65 years of age. There were 162 men (88 %) and 22 women (12 %). The median follow-up was 93.5 (66.7102.0) months. Results. The time spent in the clinic was statistically significantly shorter in the SR group than in the AF group (10 (911) and 14 (1116) hours, respectively, p 0.001). There was no statistically significant difference in the number of perioperative myocardial infarctions (in the group with SR it occurred in 1 (1.2 %) patient, in the group with AF 2 (2 %), p = 0.7), strokes (in the group with SR 1 (1.2 %), in the group with AF 3 (2.9 %), p = 0.6), as well as a 30-day mortality (in the group with SR it was 0 %, in the group with AF 3 (2.9 %), p = 0.2). In the long-term postoperative period, there were statistically significantly fewer strokes in the group with SR than in the group with AF (in the group with SR, the 10-year stroke freedom was 88.8 %, and in the group with AF 71.8 %, p = 0.018), and also better long-term survival in the group with sinus rhythm (in the group with SR, the 10-year survival rate was 79 %, in the group with AF 63.9 %, p = 0.016). Conclusions. In the group with preoperative AF, the frequency of distant strokes and deaths is higher than in patients with sinus rhythm.

scholarly journals Does new-onset postoperative atrial fibrillation after coronary artery bypass grafting affect postoperative quality of life?

2013 ◽  
Vol 146 (1) ◽  
pp. 114-118 ◽  
Author(s):  
Sander Bramer ◽  
F. Joost ter Woorst ◽  
Martijn W.A. van Geldorp ◽  
Krista C. van den Broek ◽  
Jos G. Maessen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Postoperative Quality ◽  
New Onset
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