Cohn W E, Sirois C A, Johnson R G
Division of Cardiothoracic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, 02215, USA.
J Thorac Cardiovasc Surg. 1999 Feb;117(2):298-301. doi: 10.1016/S0022-5223(99)70426-5.
Atrial fibrillation after cardiac operations is a source of morbidity and resource consumption. Various factors common to cardiac operations have been cited as causal. Comparison of the incidences of atrial fibrillation after conventional cardiac operations and minimally invasive cardiac operations may provide some insight into the mechanisms of this complication.
All patients undergoing minimally invasive direct coronary artery bypass grafting from January 26, 1996, through September 17, 1997, were evaluated for the occurrence of in-hospital postoperative atrial fibrillation. Data from these 55 patients were compared with data from a control cohort of patients undergoing conventional, solitary coronary artery bypass grafting. Each patient undergoing minimally invasive direct coronary artery bypass grafting was matched by age (+/- 3 years) and date of operation (+/- 7 days) with a patient undergoing conventional coronary artery bypass grafting.
During the period since the advent of minimally invasive direct coronary artery bypass grafting at our institution, the incidence of postoperative atrial fibrillation has been slightly lower among the patients undergoing this form of coronary artery bypass grafting (26%) than among the total population of patients undergoing conventional coronary artery bypass grafting (34%). Comparison of the age-matched groups, however, showed the incidence to be slightly but not significantly greater in the minimally invasive direct coronary artery bypass grafting cohort (13/55, 24%) than in the conventional coronary artery bypass grafting cohort (11/55, 20%; P =. 6). The minimally invasive direct coronary artery bypass grafting group was less likely to be discharged with antiarrhythmic therapy than was the conventional coronary artery bypass grafting group (6 versus 10; P =.006).
According to these data, mechanisms traditionally implicated in atrial fibrillation after coronary artery bypass grafting, such as the use of cardiopulmonary bypass, mechanical manipulation of the atrium, and atrial ischemia, are not causal but may be related to the duration of the arrhythmic complication. Strategies directed toward management and reduction of the incidence of postoperative atrial fibrillation should be focused accordingly.
心脏手术后房颤是发病和资源消耗的一个来源。心脏手术中常见的各种因素被认为是病因。比较传统心脏手术和微创心脏手术后房颤的发生率可能会为这种并发症的机制提供一些见解。
对1996年1月26日至1997年9月17日接受微创直接冠状动脉旁路移植术的所有患者进行术后住院期间房颤发生情况的评估。将这55例患者的数据与接受传统单纯冠状动脉旁路移植术的对照队列患者的数据进行比较。每例接受微创直接冠状动脉旁路移植术的患者按年龄（±3岁）和手术日期（±7天）与接受传统冠状动脉旁路移植术的患者进行匹配。
自我院开展微创直接冠状动脉旁路移植术以来，接受这种冠状动脉旁路移植术的患者术后房颤发生率（26%）略低于接受传统冠状动脉旁路移植术的患者总体发生率（34%）。然而，年龄匹配组的比较显示，微创直接冠状动脉旁路移植术队列中的发生率（13/55，24%）略高于传统冠状动脉旁路移植术队列（11/55，20%；P = 0.6），但差异无统计学意义。微创直接冠状动脉旁路移植术组出院时接受抗心律失常治疗的可能性低于传统冠状动脉旁路移植术组（6例对10例；P = 0.006）。
根据这些数据，传统上认为与冠状动脉旁路移植术后房颤有关的机制，如体外循环的使用、心房的机械操作和心房缺血，并非病因，但可能与心律失常并发症的持续时间有关。针对术后房颤的管理和降低其发生率的策略应据此重点制定。
