Atrial fibrillation after minimally invasive direct coronary artery bypasssurgery

OBJECTIVES The study compared the adjusted risk for developing atrial fibri llation (AF) after minimally invasive direct coronary artery bypass surgery (MIDCAB) and coronary artery bypass graft surgery (CABG). BACKGROUND Atrial fibrillation results in increased morbidity and delays ho spital discharge after CABG. Recently, MIDCAB has been explored as an alter native to CABG. Because of differences in surgical approach between the two procedures, the incidence of AF may differ. METHODS Randomly selected patients undergoing CABG and MIDCAB were examined . Baseline variables and postoperative course were recorded through review of medical record data. RESULTS The MIDCAB patients were younger than CABG patients (64 +/- 12 vs. 67 +/- 10, p < 0.04) and had less extensive coronary artery disease (53% of MIDCAB vs. 3% of CABG had single-vessel disease, while 15% of MIDCAB vs. 6 9% of CABG bad triple-vessel disease, p < 0.001 for overall group compariso ns). No other differences in clinical or treatment data were noted. Postope rative AF occurred less often after MIDCAB (23% vs 39%, p = 0.02). Other si gnificant factors associated with postoperative AF included age (p = 0.0024 ), prior AF (p = 0.0007), left main disease (p = 0.01), number of vessels b ypassed (p = 0.009), absence of postoperative beta-blocker therapy: (p = 0. 0001), and a serious postoperative complication (p = 0.0018). Because of di fferences between CABG and MIDCAB patients, multivariate logistic analysis was performed to determine independent predictors of postoperative AF. The type of surgery (CABG vs. MIDCAB) was no longer a significant predictor of postoperative AF (estimated relative risk for AF in CABG vs. MIDCAB patient s: 1.57, 95%, confidence interval (0.82-2.52). CONCLUSIONS Although AF appears to be less common after MIDCAB than after C ABG, the lower incidence is due to different clinical characteristics of pa tients undergoing these procedures. (C) 2000 by the American College of Car diology.