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New Technology

Invited Commentary

Division of Cardiothoracic Surgery, University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216

(Email: lcreswell{at}surgery.umsmed.edu).

One possible cause for postoperative atrial fibrillation (AF) is atrial ischemia during aortic cross clamping. When a standard two-stage venous cannula is used for cardiopulmonary bypass, the right atrium typically remains at or near systemic temperature, even when cold cardioplegia is used for ischemic arrest. Although there are probably many causative factors for postoperative AF, there is good clinical evidence that early return of electrical activity during aortic cross clamping is associated with an increased incidence of this complication.

Huybregts and colleagues [1] describe the clinical use of an innovative dual-stage venous cannula (in two incrementally improved iterations) with an inflatable cuff that allows for right atrial cooling during ischemic cardiac arrest. The authors report that the device was easy to position and that inflation and deflation of the cuff was uneventful. They note satisfactory cooling of the right atrium, suppression of electrical activity during the cross-clamp period, and immediate return of electrical activity without sustained atrial arrhythmias. Postoperative AF developed in only 3 of 38 patients (8%).

The reported rate of postoperative AF is low by most standards and may well be attributable, in part, to the right atrial cooling provided by the new cannula. Unfortunately, the report simply describes an initial experience with the new cannula and control data are not reported for patients undergoing surgery using conventional two-stage venous cannulas. Nonetheless, it is very reasonable to suspect that the new cannula design would limit the effect of atrial ischemia during the cross-clamp period. As such, this may represent an easily applied technique to combat one potential cause of postoperative AF. This could be one part of a comprehensive strategy, together with other pharmacologic and technical maneuvers, to reduce or limit the incidence of postoperative AF in adult cardiac surgery patients.

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1. Huybregts AJM, de Vroege R, van Oeveren W. A new system for right atrial cooling Ann Thorac Surg 2008;85:1421-1425.[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): Lawrence L. Creswell Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Creswell, L. L. Search for Related Content PubMed PubMed Citation Articles by Creswell, L. L. Related Collections Electrophysiology - arrhythmias Related Article