Original article
Adult cardiac
Early Restoration of Atrial Contractility After New-Onset Atrial Fibrillation in Off-Pump Coronary Revascularization

https://doi.org/10.1016/j.athoracsur.2012.09.033Get rights and content

Background

Duration of anticoagulation therapy is one of the major concerns about management of new-onset atrial fibrillation (AF) after myocardial revascularization. We evaluated whether right and left atrial contractility was restored early after electrical sinus conversion in patients who experienced new-onset AF after off-pump coronary artery bypass grafting.

Methods

From January 2009 to December 2010, 62 patients who underwent off-pump coronary artery bypass grafting and experienced new-onset AF were prospectively enrolled. Right and left atrial contractility was evaluated with transthoracic echocardiography performed 23 ± 10 hours after restoration of sinus rhythm. Anticoagulation was initiated when the AF continued for more than 24 hours.

Results

New-onset AF occurred at 2.3 ± 1.2 postoperative days, and continued or recurred for 26 ± 31 hours (>24 hours in 22 patients). Right and left atrial contractility was demonstrable after sinus conversion in all patients. Mitral inflow E and A wave velocities and the E/A ratio were 0.71 ± 0.21 m/s, 0.68 ± 0.19 m/s, and 1.15 ± 0.57, respectively. Mitral valve A′ velocity was 7.9 ± 1.9 cm/s. Tricuspid inflow E and A wave velocities and E/A ratio were 0.52 ± 0.12 m/s, 0.42 ± 0.13 m/s, and 1.30 ± 0.27, respectively. There were no significant differences in echocardiographic data between patients who had AF lasting longer than 24 hours and those with AF lasting 24 hours or less. Anticoagulation was discontinued after demonstration of atrial contractility. No patients experienced bleeding complications during anticoagulation or thromboembolic events after cessation of anticoagulation.

Conclusions

Short-term anticoagulation may be sufficient for the prevention of thromboembolic events in patients who underwent off-pump coronary artery bypass grafting and experienced new-onset AF because right and left atrial contractility was restored early after sinus conversion.

Section snippets

Patient Characteristics

The study protocol was approved by the institutional review board (approval number, H-0811-076-263), and informed consents were obtained in all study patients. Of the 338 consecutive patients who underwent isolated OPCAB between January 2009 and December 2010, 69 patients (20.4%) experienced new-onset AF after surgery. Patient inclusion criteria included (1) patients who underwent isolated OPCAB, (2) patients who experienced new-onset AF after surgery, and (3) patients who returned to sinus

Clinical Results

There was no in-hospital mortality, and none of the patients experienced acute renal failure, mediastinitis, or stroke (Table 2). New-onset AF occurred at postoperative 2.3 ± 1.2 days (range, 0 to 6 days), and continued or recurrently occurred for 26 ± 31 hours (range, 1 to 151 hours; >24 hours in 11 and >48 hours in 11; Fig 1). None of the patients underwent electrical cardioversion. Bleeding complications associated with anticoagulation did not occur, and none of the patients experienced

Comment

The present study demonstrated three main findings. First, normal sinus rhythm was restored in most patients with new-onset AF after OPCAB. Second, right and left atrial contractility was restored early after restoration of normal sinus rhythm in patients with new-onset AF. Third, anticoagulation therapy could be discontinued before hospital discharge if normal sinus rhythm was restored and maintained.

Postoperative AF usually develops within the first 4 postoperative days, having a peak

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