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Esa Salmela
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Jari Satta
Pekka Rainio
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Ann Thorac Surg 2004;77:1241-1244
© 2004 The Society of Thoracic Surgeons

Original article: cardiovascular

Postoperative atrial fibrillation is a major cause of stroke after on-pump coronary artery bypass surgery

Jarmo Lahtinen, MDa, Fausto Biancari, MD, PhDa*, Esa Salmela, MDa, Martti Mosorin, MDa, Jari Satta, MD, PhDa, Pekka Rainio, MD, PhDa, Jussi Rimpiläinen, MD, PhDa, Martti Lepojärvi, MD, PhDa, Tatu Juvonen, MD, PhDa

a Division of Cardiothoracic and Vascular Surgery, Department of Surgery, University of Oulu and Oulu University Hospital, Oulu, Finland

Accepted for publication September 22, 2003.

* Address reprint requests to Dr Biancari, Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Oulu University Hospital, PO Box 21, 90029 OYS, Finland
e-mail: faustobiancari{at}yahoo.it

BACKGROUND: Atrial fibrillation, occurring after coronary artery bypass grafting (CABG), has been suggested to be associated with the development of postoperative stroke. However, it is not clear what is the incidence of atrial fibrillation-related postoperative stroke, the timing of its occurrence, and the outcome. These issues have been investigated in a consecutive series of patients who have undergone on-pump coronary artery bypass grafting (ONCAB).

METHODS: Among 2,630 patients who underwent ONCAB, 52 patients (2.0%) experienced postoperative stroke and form the basis of the present study.

RESULTS: Twelve patients (23.1%) died postoperatively. The ischemic cerebral event occurred after a mean of 3.7 days (range, 0 to 33). In 19 patients (36.5%), atrial fibrillation preceded the occurrence of neurologic complication. These patients experienced a mean of 2.5 episodes of atrial fibrillation before the occurrence of neurologic complication. The cerebrovascular event occurred after a mean of 6.0 days in patients in whom atrial fibrillation preceded it, after a mean of 1.2 days in those with calcified ascending aorta, and after a mean of 3.1 days in those without calcified ascending aorta or in whom atrial fibrillation did not precede the cerebrovascular complication (p < 0.0001). Stroke occurred a mean of 21.3 hours after atrial fibrillation.

CONCLUSIONS: This study confirmed that atrial fibrillation, occurring after CABG, is a major determinant of postoperative stroke. Prevention of postoperative atrial fibrillation, and of formation of clots into the left atrium, may dramatically reduce the risk of postoperative stroke.




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