Can Off-Pump Coronary Artery Bypass Graft Surgery Decrease the Incidence of Postoperative Atrial Fibrillation?

非體外循環式冠狀動脈繞道手術能否降低術後心房顫動之發生機率？

林維祥(Wei-Shiang Lin) ； 劉俊廷(Jun-Ting Liou) ； 楊世平(Shih-Ping Yang) ； 蔡健松(Chien-Sung Tsai) ； 鍾明惠(Min-Huey Chung) ； 朱凱民(Kai-Min Chu)

《Acta Cardiologica Sinica》 22卷4期 (2006/12) Pp. 205-211

摘要

背景　心房顫動是冠狀動脈繞道術後最常發生之心律不整，同時也增加了術後之合併症及死亡率。由於減少對心房的撥動，非體外循環式冠狀動脈繞道手術被認為可以減少術後心房顫動之發生。
方法　225位病人接受冠狀動脈繞道手術，其中有12位病人術前即是慢性心房顫動，因此不予以分析。第一組有78位病人（53位男性，平均年齡68.6±11.9歲；25位女性，平約年齡70.7±7.9歲）接受非體外循環式冠狀動脈繞道手術，第二組有135位病人（93位男性，平均年齡72.1±10.1歲；42位女性，平均年齡72.3±7.9歲）接受體外循環式冠狀動脈繞道手術。本研究分析這兩組病人心房顫動之發生機率及其預測因子。
結果　60位病人產生術後心房顫動(28.2%)。雖然第二組病人有較高比率之心肌梗塞、陣發性心房顫動病史、鬱血性心臟衰竭、較長之插管時間及較高之併發症發生率。但是第一組(23.1%)跟第二組(31.1%)之術後心房顫動發生機率並無統計學上有意義之差別。至於術後心房顫動發生之預測因子則有：年齡大於65歲、有陣發性心房顫動病史者以及術後插管時間大於三天者。
結論　在這個回朔性的研究中，非體外循環式冠狀動脈繞道手術並不能減少術後心房顫動之發生機率。

關鍵字

心房顫動 ； 冠狀動脈繞道手術 ； 心臟電生理學

並列摘要

Background: Atrial fibrillation (AF) remains the most common cardiac arrhythmia encountered after coronary artery bypass grafting (CABG) and leads to a significant source of morbidity and mortality after the surgery. Due to its involving less manipulation of the atria, off-pump CABG was thought to have a lower incidence of postoperative AF compared with on-pump CABG.
Methods: Two hundred and twenty-five patients (154 male) underwent CABG. Preoperative permanent AF patients were excluded (n=12). Group 1 consisted of 78 patients (53 male, 68.6±11.9 years old; 25 female, 70.7±7.9 years old) who received off-pump CABG, and group 2 included 135 patients (93 male, 72.1±10.1 years old; 42 female, 72.3±7.9 years old) who underwent on-pump CABG with cardiopulmonary bypass (CPB) during the same study period. The incidence and predictors of postoperative AF were analyzed.
Results: AF developed in 60 cases (28.2%) after CABG. There were higher incidence of myocardial infarction, history of paroxysmal atrial fibrillation, NYHA Fc≧2, β-blocker use, and longer intubation in the on-pump group compared with the off-pump group. However, there was no significant difference relating to the incidence of AF between off-pump (23.1%) and on-pump (31.1%) groups. The predictors of AF were old age (＞65 years, OR: 5.008, 95% CI: 1.4-17.9, p=0.013), history of paroxysmal AF (OR: 7.851, 95%CI: 2.4-25.6, p=0.001) and prolonged postoperative intubation days (＞3 days, OR: 5.303, 95%CI: 2.2-13.1, p＜0.001).
Conclusion: In this retrospective study, off-pump CABG surgery did not decrease the incidence of postoperative AF.

並列關鍵字

Atrial fibrillation ； Coronary artery bypass grafting ； Electrophysiology