心外膜前脂肪垫保留对心胸外科手术后房颤发生率的影响：AFIST-III研究

Impact of epicardial anterior fat pad retention on postcardiothoracic surgery atrial fibrillation incidence: the AFIST-III Study.

作者信息

White C Michael, Sander Stephen, Coleman Craig I, Gallagher Robert, Takata Hiroyoshi, Humphrey Chester, Henyan Nickole, Gillespie Effie L, Kluger Jeffrey

机构信息

Division of Cardiology, Hartford Hospital, Hartford, Connecticut 06102-5037, USA.

出版信息

J Am Coll Cardiol. 2007 Jan 23;49(3):298-303. doi: 10.1016/j.jacc.2006.10.033. Epub 2007 Jan 8.

DOI:10.1016/j.jacc.2006.10.033

PMID:17239710

Abstract

OBJECTIVES

We conducted a randomized, blinded, controlled study evaluating the impact of anterior fat pad (AFP) maintenance on postoperative atrial fibrillation (POAF) incidence.

BACKGROUND

Drugs with antiadrenergic effects reduce POAF. Because the epicardial AFP is parasympathetically innervated, its routine excision during coronary artery bypass grafting (CABG) might precipitate autonomic imbalance and induce POAF.

METHODS

Patients (n = 180, mean age = 66 +/- 10 years, 80% men, 5% with previous atrial fibrillation) undergoing CABG surgery were randomized to either AFP maintenance or AFP removal. Routine prophylaxis against POAF with beta-blockers (85%) and amiodarone (28%) was allowed on the basis of caregivers' discretion. The development of POAF, total hospital costs, and heart rate variability was compared between groups.

RESULTS

Anterior fat pad maintenance did not reduce POAF incidence (34.8% vs. 35.2%, p = 0.950) or total hospital costs (data as medians with 25%, 75% percentiles: 22,940 dollars [17,629 dollars, 29,274 dollars] vs. 23,866 dollars [18,602 dollars, 30,370 dollars], p = 0.647) but was associated with higher heart rate variability (SD of normal-to-normal RR intervals [SDNN]: 31.7 +/- 24.6 vs. 22.7 +/- 8.3, p = 0.05 and SD of all 5-min mean RR intervals [SDANN 5]: 17.1 +/- 11.9 vs. 10.1 +/- 5.5, p = 0.003) than AFP removal.

CONCLUSIONS

Maintaining the AFP prevents attenuation of parasympathetic tone after CABG but does not reduce POAF or total hospital costs in any appreciable way.

摘要

目的

我们进行了一项随机、双盲、对照研究，评估保留前脂肪垫（AFP）对术后房颤（POAF）发生率的影响。

背景

具有抗肾上腺素能作用的药物可降低POAF。由于心外膜AFP受副交感神经支配，在冠状动脉旁路移植术（CABG）期间常规切除AFP可能会导致自主神经失衡并诱发POAF。

方法

接受CABG手术的患者（n = 180，平均年龄 = 66±10岁，80%为男性，5%有既往房颤病史）被随机分为保留AFP组或切除AFP组。根据护理人员的判断，允许常规使用β受体阻滞剂（85%）和胺碘酮（28%）预防POAF。比较两组患者POAF的发生情况、总住院费用和心率变异性。

结果

保留AFP并未降低POAF发生率（34.8%对35.2%，p = 0.950）或总住院费用（数据为中位数及25%、75%百分位数：22,940美元[17,629美元，29,274美元]对23,866美元[18,602美元，30,370美元]，p = 0.647），但与切除AFP相比，心率变异性更高（正常到正常RR间期标准差[SDNN]：31.7±24.6对22.7±8.3，p = 0.05；所有5分钟平均RR间期标准差[SDANN 5]：17.1±11.9对10.1±5.5，p = 0.003）。