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Ann Thorac Surg 2007;84:66
© 2007 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Invited commentary

Department of Cardiac Surgery, Ludwig-Maximilians-University Munich, Großhadern Medical Center, Marchioninistr 15, Munich, 81377 Germany

(Email: calin.vicol{at}med.uni-muenchen.de).

Atrial fibrillation (AF) is the most frequent arrhythmic complication after coronary artery bypass grafting (CABG). Despite continuous development of surgical procedures, anaesthesia, and postoperative intensive care, the frequency of postoperative AF remains high. Various measurements have been identified as triggers for this complication. These include age, diabetes mellitus, renal insufficiency, reduced left ventricular ejection fraction, left atrial dilatation, preoperative antiarrhythmic therapy, and long aortic cross-clamp time. Identification and control of potential triggers for postoperative AF may prevent this complication and thus avoid related further complications.

In this prospective and to some extent, the blinded study by Budeus and colleagues [1] analyzed the predictive value of withdrawing beta-blocker therapy on the occurrence of AF in patients with a sympathovagal imbalance undergoing CABG surgery. The authors concluded that the identified measurements are powerful predictors for postoperative development of AF. The issue of beta-blocker withdrawal causing AF after cardiac surgery is not a new concept; however, the connection to a disturbance of the autonomic nervous system characterized by a lower standard deviation of all normal RR intervals to AF is meritorious. Furthermore they discuss the potential causal role of diabetes mellitus in this patient population. Based on their results, the authors recommend continuation of beta-blocker therapy after CABG surgery in patients with a sympathovagal imbalance. This conclusion has an important consequence for postoperative therapy after CABG surgery. The significance of the findings to some extent may be altered by the inclusion criteria into the groups of patients with a withdrawal of beta-blocker therapy after surgery. The authors did not randomize the patients but withdrew beta-blockers because of intolerance to these drugs.

The article of Budeus and colleagues [1] gives us more understanding in regard to possible determinants of postoperative AF in patients undergoing CABG surgery, and at the same time it supports the strategy of postoperative continuation of beta-blocker therapy in this patient population.

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1. Budeus M, Feindt P, Gams E, et al. ß-Blocker prophylaxis for atrial fibrillation after coronary artery bypass grafting in patients with sympathovagal imbalance Ann Thorac Surg 2007;84:61-66.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Calin Vicol Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Vicol, C. Search for Related Content PubMed PubMed Citation Articles by Vicol, C. Related Collections Electrophysiology - arrhythmias Related Article