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Ann Thorac Surg 2001;71:1491-1495
© 2001 The Society of Thoracic Surgeons

Original article: cardiovascular

Atrial fibrillation: prevalence after minimally invasive direct and standard coronary artery bypass

Marilyn Hravnak, RN, PhDa,*, Leslie A Hoffman, RN, PhDa, Melissa I Saul, MSb, Thomas G Zullo, PhDa, Julie F Cuneo, RN, MSNa, Gayle R Whitman, RN, PhDa, John M Clochesy, RN, PhDd, Bartley P Griffith, MDc

a Department of Acute/Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
b Medical Archival System, Inc, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
c Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
d Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA

Accepted for publication January 17, 2001.

* Address reprint requests to Dr Hravnak, Department of Acute/Tertiary Care, School of Nursing, University of Pittsburgh, 314 Victoria Bldg, 3500 Victoria St, Pittsburgh, PA 15261 (Email: mhra{at}pitt.edu).

Background. This study identified and compared the prevalence of new-onset atrial fibrillation (AFIB) following standard coronary artery bypass grafting (SCABG) with cardiopulmonary bypass (CPB) and minimally invasive direct vision coronary artery bypass grafting (MIDCAB) without CPB. A further comparison was made between AFIB prevalence in SCABG and MIDCAB subjects with two or fewer bypasses.

Methods. This is a retrospective, comparative survey. Patients with new-onset AFIB who underwent SCABG or MIDCAB alone were identified electronically using a triangulated method (International Classification of Diseases, 9th revision, Clinical Modification [ICD-9 CM] code; clinical database word search; and pharmacy database drug search).

Results. The total sample (n = 814; 94 MIDCAB, 720 SCABG) exhibited a trend toward lower AFIB prevalence in MIDCAB (23.4%) versus SCABG (33.1%) subjects (p = 0.059). AFIB prevalence in the SCABG subset with two or less vessel bypasses (n = 98; n = 18 single vessel, n = 80 double vessels) and MIDCAB subjects (n = 94; n = 90 single vessels, n = 4 double vessels) was almost identical (SCABG subset 24.5% versus MIDCAB 23.4%, p = 0.860). Slightly more than half (56.9%) of new-onset AFIB subjects were identified by ICD-9 CM codes, with the remainder by word search (37.7%) or procainamide query (5.4%).

Conclusions. In this sample, the number of vessels bypassed seemed to have a greater influence on AFIB prevalence than the application of CPB or the surgical approach. Retrospective identification of AFIB cases by ICD-9 CM code grossly underestimated AFIB prevalence.




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