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Ann Thorac Surg 2001;72:65-71
© 2001 The Society of Thoracic Surgeons

Original article: cardiovascular

Thoracic epidural anesthesia does not influence the occurrence of postoperative sustained atrial fibrillation

Lena Jidéus, MDa, Per-Olof Joachimsson, MD, PhDb, Mats Stridsberg, MD, PhDb, Mats Ericson, MD, PhDc, Hans Tydén, MD, PhDb, Leif Nilsson, MD, PhDa, Per Blomström, MD, PhDc, Carina Blomström-Lundqvist, MD, PhDc a Departments of Surgical Sciences, Thoracic and Cardiovascular Surgery, University Hospital, Uppsala, Sweden
b Department of Cardiothoracic Anesthesiology, Medical Sciences, Clinical Chemistry and Cardiology, University Hospital, Uppsala, Sweden
c Department of Human Resources, Management and Environment, Mid Sweden University, Östersund, Sweden

Accepted for publication March 4, 2001.

Address reprint requests to Dr Jidéus, Department of Thoracic and Cardiovascular Surgery, University Hospital, S-751 85 Uppsala, Sweden
e-mail: lena.jideus{at}kirurgi.uu.se

Background. To evaluate whether thoracic epidural anesthesia (TEA) can reduce the incidence of atrial fibrillation (AF) after coronary artery bypass grafting (CABG).

Methods. Forty-one patients undergoing CABG were treated with TEA intraoperatively and postoperatively. Another 80 patients served as the control group. The sympathetic and parasympathetic activities were evaluated by analysis of neuropeptides, catecholamines and heart rate variability (HRV), preoperatively and postoperatively.

Results. Postoperative AF occurred in 31.7% of the TEA-treated patients and in 36.3% of the untreated patients (p = 0.77). TEA significantly suppressed sympathetic activity, as indicated by a less pronounced increase of norepinephrine and epinephrine (p = 0.03, p = 0.02) and a significant decrease of neuropeptide Y (p = 0.01) postoperatively in TEA-treated patients compared to untreated patients. The HRV variable expressing sympathetic activity was significantly lower and the postoperative increase in heart rate was significantly less in the TEA group than in the control group after surgery (p = 0.01, p < 0.001). Among patients developing AF, the maximal number of supraventricular premature beats per minute increased significantly in untreated patients postoperatively but remained unchanged in TEA-treated patients (p = 0.004 versus p = 0.86).

Conclusions. TEA has no effect on the incidence of postoperative sustained AF, despite a significant reduction in sympathetic activity.




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