Cardiovascular Surgery Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
J Thorac Cardiovasc Surg. 2010 Nov;140(5):1036-9. doi: 10.1016/j.jtcvs.2009.12.024. Epub 2010 Mar 11.
This study assessed the prophylactic effect of ventral cardiac denervation on reducing atrial fibrillation after coronary artery bypass grafting.
This randomized prospective study recruited 220 adult patients (aged 42-79 years) who were scheduled to undergo coronary artery bypass grafting. Of these patients, 110 underwent ventral cardiac denervation in addition to coronary artery bypass grafting and 110 underwent only coronary artery bypass grafting. The demographic, intraoperative, and postoperative factors comprising atrial fibrillation were compared between the 2 groups. In addition, the predictive factors of atrial fibrillation in all 220 cases were assessed.
The mean age and the distribution of gender, body mass index, diabetes mellitus, chronic obstructive pulmonary disease, hypertension, hypercholesterolemia, and left main disease were not significantly different between the 2 groups. Atrial fibrillation incidence was significantly different between the groups (P=.025), with an incidence of 20.9% in the ventral cardiac denervation group and 10% in the control group. Atrial fibrillation occurred in 34 of the 220 patients, and ventral cardiac denervation was considered as a variable to evaluate its possible role in the prevention of postoperative atrial fibrillation. Our multivariate analysis showed age (P=.002; odds ratio,1.098; confidence interval, 1.034-1.165) and ventral cardiac denervation (P=.044; odds ratio,2.32; confidence interval, 1022-5.298) as the predictive factors of atrial fibrillation after coronary artery bypass grafting.
Given the surprising results of the present study demonstrating that ventral cardiac denervation is a predictive factor of atrial fibrillation after coronary artery bypass grafting, ventral cardiac denervation should not be routinely considered for the prevention of atrial fibrillation after coronary artery bypass grafting.
本研究评估了心脏前表面去神经支配对减少冠状动脉旁路移植术后心房颤动的预防作用。
这是一项随机前瞻性研究，共纳入 220 例（年龄 42-79 岁）拟行冠状动脉旁路移植术的成年患者。其中 110 例行心脏前表面去神经支配术联合冠状动脉旁路移植术，110 例行单纯冠状动脉旁路移植术。比较两组患者的人口统计学、术中及术后房颤相关因素。此外，评估了 220 例患者中房颤的所有预测因素。
两组患者的平均年龄以及性别、体重指数、糖尿病、慢性阻塞性肺疾病、高血压、高胆固醇血症和左主干疾病的分布无显著差异。两组心房颤动发生率有显著差异（P=.025），心脏前表面去神经支配组发生率为 20.9%，对照组为 10%。220 例患者中有 34 例发生心房颤动，将心脏前表面去神经支配视为评估其在预防术后心房颤动中可能作用的变量。多变量分析显示年龄（P=.002；比值比，1.098；95%置信区间，1.034-1.165）和心脏前表面去神经支配（P=.044；比值比，2.32；95%置信区间，1022-5.298）是冠状动脉旁路移植术后心房颤动的预测因素。
鉴于本研究结果令人惊讶地表明心脏前表面去神经支配是冠状动脉旁路移植术后心房颤动的预测因素，因此心脏前表面去神经支配不应常规用于预防冠状动脉旁路移植术后心房颤动。
