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European Heart Journal 1991 12(10):1107-1111;
Copyright © 1991 by the European Society of Cardiology.
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© 1991 The European Society of Cardiology

Ventricular conduction defects and atrial fibrillation after coronary artery bypass grafting. Multivariate analysis of preoperative, intraoperative and postoperative variables

Q. CARETTA*, C. A. MERCANTI*, D. DE NARDO{dagger}, F. CHIAROTTI{ddagger}, G. SCIBILIA§, THE LATE A. REALE§ and B. MARINO*

*Istituto di Chirurgia del Cuore e Grossi Vasi, Università di Roma, La Sapienza
{dagger}tServizio di Medicina Nucleare, Università di Roma, La Sapienza
§II Cattedra di Malattie dell'Apparato Cardiovascolare, Università di Roma, La Sapienza
{ddagger}Istituto Superiore di Sanità, Roma

Received 26 March 1990; revised 6 December 1990; .

Correspondence: Dr Quintilio Caretta, Istituto di Chirurgia del Cuoree Grossi Vast, Policlinico Umberto I, Viale del Policlinico, 00161 Roma, Italy

Abstract

Preoperative, intraoperative and postoperative variables, which might play a role in the development of ventricular conduction defects (VCD) and atrial fibrillation (AF) following coronary artery bypass grafting (CABG), were evaluated in 236 consecutive patients. VCD and AF developed postoperatively in 15·5% of patients. 4·5% had VCD (subgroup A), 11·0% had AF (subgroup B). In 84·5 of patients VCD and AF did not occur (subgroup C). Univariate analysis showed statistically significant differenes between subgroups A and C with respect to. left main sign stenoses and number of diseased vessels. Bypass pump time and aortic cross-clamp time were significantly longer in subgroup B. Multivariate analysis showed a significantly greater incidence of left main disease and of right coronary artery occlusion associated with significant stenosis of the proximal left anterior descending artery in subgroup A. In subgroup B, the duration of aortic cross-clamp time was signficantly higher.

Ischaemic injury, with increasing duration of cardioplegic arrest, seems to play a key role in the development of AF. Nonhomogeneous cardioplegic delivery to critical areas of myocardium, and particularly to the specialized conducting system, may cause VCD after CABG.

Key Words: Conduction disturbances • atrial fibrillation • myocardial revascularization • myocardial protection


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