Short-term sinus rhythm predicts long-term sinus rhythm and clinical improvement after intraoperative ablation of atrial fibrillation. Effectiveness of Bi-atrial Pacing for Reducing Atrial Fibrillation after Coronary Artery Bypass Graft Surgery Preoperative atrial fibrillation is an independent risk factor for mid-term mortality after concomitant aortic valve replacement and coronary artery bypass graft surgery. Comparison of cardiac surgery with left atrial surgical ablation vs. cardiac surgery without atrial ablation in patients with coronary and/or valvular heart disease plus atrial fibrillation: final results of the PRAGUE-12 randomized multicentre study† Corticosteroids for the prevention of atrial fibrillation after cardiac surgery: a randomized controlled trial. Relation of an exaggerated rise in white blood cells after coronary bypass or cardiac valve surgery to development of atrial fibrillation postoperatively. Comparison of effectiveness of carvedilol versus metoprolol or atenolol for atrial fibrillation appearing after coronary artery bypass grafting or cardiac valve operation. Effect of dietary fish oil on atrial fibrillation after cardiac surgery. Statins improve surgical ablation outcomes for atrial fibrillation in patients undergoing concomitant cardiac surgery. Endoscopic Vascular Harvest in Coronary Artery Bypass Grafting Surgery: A Consensus Statement of the International Society of Minimally Invasive Cardiothoracic Surgery (ISMICS) 2005 The effects of atorvastatin on the occurrence of postoperative atrial fibrillation after off-pump coronary artery bypass grafting surgery. Left atrial radiofrequency ablation during cardiac surgery in patients with atrial fibrillation. Magnesium infusion dramatically decreases the incidence of atrial fibrillation after coronary artery bypass grafting. Omega-3 Fatty Acid Supplementation Does Not Reduce Risk of Atrial Fibrillation After Coronary Artery Bypass Surgery: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial Effective prevention of atrial fibrillation by continuous atrial overdrive pacing after coronary artery bypass surgery. Preoperative high-dose atorvastatin for prevention of atrial fibrillation after cardiac surgery: a randomized controlled trial. Physical conditioning and mental stress reduction - a randomised trial in patients undergoing cardiac surgery Atrial Fibrillation After Isolated Coronary Surgery Affects Late Survival Perioperative magnesium supplementation to prevent atrial fibrillation after off-pump coronary artery surgery: a randomized controlled study. Results of a Minimally Invasive Surgical Pulmonary Vein Isolation and Ganglionic Plexi Ablation for Atrial Fibrillation: Single-Center Experience With 12-Month Follow-Up Efficacy of acupuncture in prevention of postoperative nausea in cardiac surgery patients. Beta-blocker effects on postoperative atrial fibrillation. Usefulness of neutrophil/lymphocyte ratio as predictor of new-onset atrial fibrillation after coronary artery bypass grafting.
AIMS Our aim was to compare the long-term effects on rhythm and quality of life ( QoL ) after left atrial epicardial radiofrequency ( RF ) ablation vs. no ablation in patients undergoing cardiac surgery . METHODS AND RESULTS Thirty-nine patients with ECG documented atrial fibrillation ( AF ) scheduled for coronary artery bypass grafting ( CABG ) with or without concomitant valve surgery were consecutively elected for epicardial RF ablation .  Thirty-nine age- and gender-matched patients scheduled for CABG with or without concomitant valve surgery only and with documented AF served as controls . The follow-up after ablation was 32 + /- 11 months . The percentage of patients in sinus rhythm ( SR ) at long-term follow-up was 62 vs. 33 % ( P = 0.03 ) after ablation and no ablation , respectively . SR at 3 months was highly predictive of that at 32 months ( sensitivity 95 % , positive predictive value 86 % ) . Long-term SR was associated with better QoL , fewer symptoms , higher ejection fraction , and smaller left and right atria than AF . CONCLUSION SR at 3 months was highly predictive of long-term SR that was associated with clinical improvement when compared with patients still in AF . AF at 3 months did not preclude a later stabilization to SR Atrial fibrillation ( AF )  is common after cardiac surgery and adds significant cost and morbidity . The use of prophylactic pacing strategies to prevent post-operative AF has been controversial . We previously performed a pilot study which suggested that the combination of beta-blockers and bi-atrial pacing ( BAP ) may reduce AF after cardiac surgery . We prospect ively r and omized 118 patients to continuous BAP for up to 96 hours post-operatively versus st and ard therapy .  All patients were treated with beta-blockers as tolerated . Patients were paced in the AAI mode at a rate of 100 pulses per minute . The primary endpoint of the study was the occurrence of sustained AF ( > 10 minutes).There was a significant reduction in the incidence of AF in the BAP group among patients undergoing coronary artery bypass graft surgery with or without aortic valve replacement ( 35 % vs. 19 % AF ; OR=0.38 , 95 % CI 0.15 , 0.93 ; p < 0.05 ) . Including patients undergoing isolated aortic valve surgery ( n=7 ) , there remained a strong trend toward a reduction of AF with pacing ( no atrial pacing [ NAP ] vs. BAP ; 35 % vs. 21 % AF ; OR=0.48 , 95 % CI 0.21 , 1.11 ; p=0.08 ) . Patients age 70 or greater benefited most from pacing ( NAP vs. BAP ; 55 vs. 25 % AF ; p<0.05 ) , while those less than 70 years of age did not ( 17 vs. 18 % p = NS ) . There was a significant reduction in the amount of time spent in the intensive care unit among patients receiving BAP ( 50±40 vs. 37±25[emsp4 ] h ; p<0.05).BAP together with beta-blockade after coronary artery bypass graft surgery reduces the incidence of post-operative atrial AF .  Elderly patients ( age 70 or greater ) appear to benefit most , and may be a group to whom this therapy should be targeted OBJECTIVES Preoperative atrial fibrillation ( PAF )  has been associated with poorer early and mid-term outcomes after isolated valvular or coronary artery bypass graft surgery . Few studies , however , have evaluated the impact of PAF on early and mid-term outcomes after  concomitant aortic valve replacement and coronary aortic bypass graft ( AVR-CABG ) surgery . METHODS Data obtained prospect ively between June 2001 and December 2009 by the Australian and New Zeal and Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Data base Program was retrospectively analysed . Patients who underwent concomitant atrial arrhythmia surgery/ablation were excluded . Demographic and operative data were compared between patients undergoing concomitant AVR-CABG  who presented with PAF and those who did not using chi-square and t-tests . The independent impact of PAF on 12 short-term complications and mid-term mortality was determined using binary logistic and Cox regression , respectively . RESULTS Concomitant AVR-CABG surgery was performed in 2563 patients ; 322 ( 12.6 % ) presented with PAF . PAF patients were generally older ( mean age 76 vs 74 years ; P < 0.001 ) and presented more often with comorbidities including congestive heart failure , chronic pulmonary disease and cerebrovascular disease ( all P < 0.05 ) . PAF was associated with 30-day mortality on univariate analysis ( P = 0.019 ) but not multivariate analysis ( P = 0.53 ) . The incidence of early complications was not significantly higher in the PAF group . PAF was independently associated with reduced mid-term survival ( HR , 1.58 ; 95 % CI , 1.14 - 2.19 ; P = 0.006 ) . CONCLUSIONS PAF is associated with reduced mid-term survival after concomitant AVR-CABG surgery .  Patients with PAF undergoing AVR-CABG  should be considered for a concomitant surgical ablation procedure Aims Surgical ablation procedure can restore sinus rhythm ( SR ) in patients with atrial fibrillation ( AF ) undergoing cardiac surgery . However , it is not known whether it has any impact on long-term clinical outcomes . Methods and results This multicentre study r and omized 224 patients with AF scheduled for valve and /or coronary surgery : group A  ( left atrial surgical ablation , n = 117 ) vs. group B  ( no ablation , n = 107 ) . The primary efficacy outcome was the SR presence ( without any AF episode ) during a 24 h electrocardiogram ( ECG )  after 1 year . The primary safety outcome was the combined endpoint of death/myocardial infa rct ion/stroke/renal failure at 30 days . A Holter-ECG after 1 year revealed SR in 60.2 % of group A patients vs. 35.5 % in group B ( P = 0.002 ) . The combined safety endpoint at 30 days occurred in 10.3 % ( group A ) vs. 14.7 % ( group B , P = 0.411 ) . All-cause 1-year mortality was 16.2 % ( A ) vs. 17.4 % ( B , P = 0.800 ) . Stroke occurred in 2.7 % ( A ) vs. 4.3 % ( B ) patients ( P = 0.319 ) . No difference ( A vs. B ) in SR was found among patients with paroxysmal ( 61.9 vs. 58.3 % ) or persistent ( 72 vs. 50 % ) AF , but ablation significantly increased SR prevalence in patients with longst and ing persistent AF ( 53.2 vs. 13.9 % , P < 0.001 ) . Conclusion Surgical ablation improves the likelihood of SR presence post-operatively without increasing peri-operative complications . However , the higher prevalence of SR did not translate to improved clinical outcomes at 1 year . Further follow-ups ( e.g. 5-year ) are warranted to show any potential clinical benefit which might occur later CONTEXT Atrial fibrillation ( AF ) is the most common arrhythmia to occur after cardiac surgery . An exaggerated inflammatory response has been proposed to be one etiological factor . OBJECTIVE To test whether intravenous corticosteroid administration after cardiac surgery prevents AF after cardiac surgery . DESIGN , SETTING , AND PATIENTS A double-blind , r and omized multicenter trial ( study enrollment August 2005-June 2006 ) in 3 university hospitals in Finl and of 241 consecutive patients without prior AF or flutter and scheduled to undergo first on-pump coronary artery bypass graft ( CABG ) surgery , aortic valve replacement , or combined CABG surgery and aortic valve replacement . INTERVENTION Patients were r and omized to receive either 100-mg hydrocortisone or matching placebo as follows : the first dose in the evening of the operative day , then 1 dose every 8 hours during the next 3 days . In addition , all patients received oral metoprolol ( 50 - 150 mg/d ) titrated to heart rate . MAIN OUTCOME MEASURE Occurrence of AF during the first 84 hours after cardiac surgery . RESULTS The incidence of postoperative AF was significantly lower in the hydrocortisone group ( 36/120 [ 30 % ] ) than in the placebo group ( 58/121 [ 48 % ] ; adjusted hazard ratio , 0.54 ; 95 % confidence interval , 0.35 - 0.83 ; P = .004 ; number needed to treat , 5.6 ) . Compared with placebo , patients receiving hydrocortisone did not have higher rates of superficial or deep wound infections , or other major complications . CONCLUSION Intravenous hydrocortisone reduced the incidence of AF after cardiac surgery . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00442494 This study investigated the correlation between an elevated white blood cell ( WBC ) count as a marker of inflammation and the development of  atrial fibrillation ( AF ) after cardiac surgery .  WBC counts  were prospect ively followed in 181 consecutive patients who underwent coronary bypass or cardiac valve surgery  to determine if a baseline or postoperative WBC count elevation is an independent predictor of postoperative AF A retrospective review of 115 patients who underwent cardiac surgery demonstrated a marked reduction in postoperative atrial fibrillation ( 8 % vs 32 % , p < 0.05 ) in patients who received carvedilol versus metoprolol or atenolol immediately after surgery . A prospect i ve study examining the possibility of carvedilol 's greater efficacy in preventing postoperative atrial fibrillation appears warranted An open-label study reported that ingestion of a fish oil concentrate decreased the incidence of  atrial fibrillation ( AF ) after coronary artery bypass grafting ( CABG ) surgery . However , a general cardiac surgery population involves valve and CABG surgeries . We undertook a double-blinded r and omized controlled trial to examine the effectiveness of fish oil supplementation on the incidence of  postsurgical AF after CABG and valve procedures . The primary end point was incidence of AF in the first 6 days after surgery . Two hundred patients were r and omized to receive fish oil ( providing 4.6 g/day of long-chain ω-3 fatty acids ) or a control oil starting 3 weeks before surgery ; 194 subjects completed the study , with 47 of 97 subjects in the control group and 36 of 97 subjects in the fish oil group developing AF ( odds ratio 0.63 , 95 % confidence interval [ CI ] 0.35 to 1.11 ) . There was a nonstatistically significant delay in time to onset of AF in the fish oil group ( hazard ratio 0.66 , 95 % CI 0.43 to 1.01 ) . There was a significant decrease in mean length of stay in the intensive care unit in the fish oil group ( ratio of means 0.71 , 95 % CI 0.56 to 0.90 ) . In conclusion , in a mixed cardiac surgery population , supplementation with dietary fish oil did not result in a significant decrease in the incidence of postsurgical AF . However , there was a significant decrease in time spent in the intensive care unit Ablation outcomes were investigated in patients with and without statin pretreatment before cardiac surgery with concomitant surgical ablation for atrial fibrillation ( AF ) . A prospect i ve cohort study was performed containing 149 patients ( n=73 statin group vs. n=76 control group ) undergoing on-pump cardiac procedures with surgical ablation for paroxysmal or persistent AF . Measured outcomes were freedom from AF in the intensive care unit , discharge and at three and six months follow-up and perioperative markers of inflammation ( white blood cell count , C-reactive protein ) . Independent predictors for freedom from AF were assessed . Groups did not differ with respect to EuroSCORE , New York Heart Association class , left atrial size , anti-arrhythmic drug therapy or aortic cross-clamp time . Statin therapy had no impact on postoperative inflammatory markers . Freedom from AF was more frequent in the statin group at discharge ( P=0.07 ) and after three and six months ( P<0.05 ) . Subgroup analysis showed that statin pretreatment was associated with higher rates of freedom from AF for paroxysmal AF at three and six months and for persistent AF after six months ( P<0.05 ) . Importantly , statin-pretreatment was independently predictive for freedom from AF at discharge [ odds ratio ( OR ) : 3.21 ; 95 % confidence interval ( CI ) : 1.2 - 8.55 ; P=0.02 ] and at three months ( OR : 2.91 ; 95 % CI : 1.14 - 7.45 ; P=0.026 ) . Statin therapy prior to ablation surgery improves postoperative freedom from AF for paroxysmal and persistent AF in cardiac surgery patients Objective This purpose of this consensus statement was to compare endoscopic vascular graft harvesting ( EVH ) with conventional open vascular harvesting ( OVH ) in adults undergoing coronary artery bypass grafting ( CABG ) surgery and to determine which result ed in improved clinical and re source outcomes . Methods Before the consensus conference , the consensus panel review ed the best available evidence , whereby systematic review s , r and omized trials , and nonr and omized trials were considered in descending order of importance . Evidence -based statements were created , and consensus processes were used to determine the ensuing statements . The AHA/ACC system was used to label the level of evidence and class of recommendation . Results The consensus panel agreed upon the following statements : 1 . EVH is recommended to reduce wound related complications when compared with OVH ( Class I , Level A ) . 2 . Based on quality of conduit harvested , either endoscopic or open vein harvest technique may be used ( Class IIa ; Level B ) . 3 . Based on major adverse cardiac events and angiographic patency at 6 months , either endoscopic or open vein harvest technique may be used ( Class IIa ; Level A ) . 4 . EVH is recommended for vein harvesting to improve patient satisfaction and postoperative pain when compared with OVH in CABG surgery ( Class I , Level A ) . 5 . EVH is recommended for vein harvesting to reduce postoperative length of stay and outpatient wound management re sources ( Class I , Level A ) . Conclusions Given these evidence -based statements , the consensus panel stated that EVH should be the st and ard of care for patients who require saphenous vein grafts for coronary revascularization ( Class I , Level B ) . Future research should address long-term safety , cost-effectiveness , and endoarterial harvest BACKGROUND  Atrial fibrillation ( AF ) after coronary artery bypass graft ( CABG ) surgery is still the most common arrhythmic complication . This study evaluated whether pretreatment with atorvastatin protects against AF after off-pump CABG . METHODS One hundred twenty-four patients without a history of AF or previous statin use , who were scheduled to undergo elective off-pump CABG , were enrolled . Patients were r and omized to control group ( n = 62 ) or to atorvastatin group ( n = 62 ) who were administered  atorvastatin 20 mg/d for 3 days before the surgery . Primary outcome was the incidence of postoperative AF . Secondary outcomes were major adverse cardiac and cerebrovascular events , persistent AF at 1 month , and identification of the markers to predict inhospital postoperative AF . RESULTS The incidence of AF was significantly lower in the atorvastatin group than in the control group ( 13 % vs 27 % , P = .04 ) . The incidence of major adverse cardiac and cerebrovascular events and persistent AF at 1 month was similar in comparisons between the groups . Postoperative peak N-terminal pro-brain natriuretic peptide levels were significantly higher in the patients with AF ( P = .03 ) . Multivariate analysis identified pretreatment with atorvastatin as an independent factor associated with a significant reduction in postoperative AF ( odds ratio 0.34 , P = .04 ) . Higher postoperative peak N-terminus pro-B-type natriuretic peptide levels were associated with the development of postoperative AF ( odds ratio 1.02 per 100 pg/mL , P = .03 ) . CONCLUSIONS Pretreatment with atorvastatin significantly reduced the occurrence of postoperative AF after off-pump CABG INTRODUCTION Intraoperative left atrial radiofrequency ( RF ) ablation recently has been suggested as an effective surgical treatment for atrial fibrillation ( AF ) . The aim of this study was to verify the outcome of this technique in a controlled multicenter trial . METHODS AND RESULTS One hundred three consecutive patients ( 39 men and 65 women ; age 62 + /- 11 years ) affected by AF underwent cardiac surgery and RF ablation in the left atrium ( RF group ) . The control group consisted of 27 patients ( 6 men and 21 women ; age 64 + /- 7 years ) with AF who underwent cardiac surgery during the same period and refused RF ablation .  Mitral valve disease was present in 89 ( 86 % ) and 25 ( 92 % ) patients , respectively ( P = NS ) . RF endocardial ablation was performed in order to obtain isolation of both right and left pulmonary veins , a lesion connecting the previous lines , and a lesion connecting the line encircling the left veins to the mitral annulus . Upon discharge from the hospital , sinus rhythm was present in 65 patients ( 63 % ) versus 5 patients ( 18 % ) in the control group ( P < 0.0001 ) . Mean time of cardiopulmonary bypass was longer in the RF group ( 148 + /- 50 min vs 117 + /- 30 min , P = 0.013 ) . The complication rate was similar in both groups , but RF ablation-related complications occurred in 4 RF group patients ( 3.9 % ) . After a mean follow-up of 12.5 + /- 5 months ( range 4 - 24 ) , 83 ( 81 % ) of 102 RF group patients were in stable sinus rhythm versus 3 ( 11 % ) of 27 in the control group ( P < 0.0001 ) . The success rate was similar among the four surgical centers . Atrial contraction was present in 66 ( 79.5 % ) of 83 patients in the RF group in sinus rhythm . CONCLUSION Endocardial RF left atrial compartmentalization during cardiac surgery is effective in restoring sinus rhythm in many patients . This technique is easy to perform and reproducible . Rare RF ablation-related complications can occur . During follow-up , sinus rhythm persistence is good , and biatrial contraction is preserved in most patients BACKGROUND  Atrial fibrillation ( AF )  is one of the most common complications of cardiac surgery . Magnesium , like several other pharmacologic agents , has been used in the prophylaxis of postoperative AF with varying degrees of success . However , the dose and the timing of magnesium prophylaxis need to be clarified . The purpose of this study was to assess the effect of intermittent magnesium infusion on postoperative AF . METHODS A total of 200 consecutive patients who had elective , isolated , first-time coronary artery bypass grafting were prospect ively r and omized to two groups . Patients in the magnesium group ( n = 100 ) received 6 mmol MgSO4 infusion in 100 mL 0.9 % NaCl solution ( 25 mL/h ) the day before surgery , just after cardiopulmonary bypass , and once daily for 4 days after surgery . Patients in the control group ( n = 100 ) received only 100 mL 0.9 % NaCl solution ( 25 mL/h ) at the same time points . RESULTS Postoperative AF occurred in 2 ( 2 % ) patients in the magnesium group and in 21 ( 21 % ) patients in the control group ( p < 0.001 ) . Atrial fibrillation started , on average , 49.4 + /- 16.8 hours postoperatively . The postoperative length of hospital stay was not significantly different in patients with AF ( 7.4 + /- 8.0 days ) compared with patients without AF ( 5.4 + /- 1.1 days ; p = 0.236 ) . CONCLUSIONS The use of magnesium in the preoperative and early postoperative periods is highly effective in reducing the incidence of AF after coronary artery bypass grafting Background —Omega-3 polyunsaturated fatty acids ( n-3 PUFA ) have been reported to reduce the risk of sudden cardiac death presumed to be due to fatal ventricular arrhythmias , but their effect on atrial arrhythmias is unclear . Methods and Results — Patients ( n=108 ) undergoing coronary artery bypass graft surgery were r and omly assigned to receive 2 g/d n-3 PUFA or placebo ( olive oil ) for at least 5 days before surgery ( median , 16 days ; range , 12 to 21 days ) . Phospholipid n-3 PUFA were measured in serum at study entry and at surgery and in right atrial appendage tissue at surgery . Echocardiography was used to assess left ventricular function and left atrial dimensions .  Postoperative continuous ECG monitoring ( Lifecard CF ) for 5 days or until discharge , if earlier , was performed with a daily 12-lead ECG and clinical review if patients remained in the hospital beyond 5 days . Lifecard recordings were analyzed for episodes of atrial fibrillation ( AF ) ≥30 seconds ( primary outcome ) . Clinical AF , AF burden ( % time in AF ) , hospital stay , and intensive care/high dependency care stay were measured as secondary outcomes . One hundred three patients completed the study ( 51 in the placebo group and 52 in the n-3 PUFA group ) . There were no clinical ly relevant differences in baseline characteristics between groups . n-3 PUFA levels were higher in serum and right atrial tissue in the active treatment group . There was no significant difference between groups in the primary outcome of AF ( 95 % confidence interval [ CI ] , −6 % to 30 % , P=0.28 ) in any of the secondary outcomes or in AF-free survival . Conclusions —Omega-3 PUFA do not reduce the risk of AF after coronary artery bypass graft surgery . Clinical Trial Registration —www.ukcrn.org.uk . Identifier : 4437 OBJECTIVES The present study was aim ed to evaluate the efficacy of a specific algorithm with continuous atrial dynamic overdrive pacing to prevent atrial fibrillation ( AF ) after coronary artery bypass graft ( CABG ) surgery . BACKGROUND Atrial fibrillation occurs in 30 % to 40 % of patients after cardiac surgery with a peak incidence on the second day . It still represents a challenge for postoperative prevention and treatment and may have medical and cost implication s. METHODS Ninety-six consecutive patients undergoing CABG for severe coronary artery disease and in sinus rhythm without antiarrhythmic therapy on the second postoperative day were r and omized to have or not 24 h of atrial pacing through temporary epicardial wires using a permanent dynamic overdrive algorithm .  Holter ECGs recorded the same day in both groups were analyzed to detect AF occurrence . RESULTS No difference was observed in baseline data between the two study groups , particularly for age , male gender , history of AF , ventricular function , severity of coronary artery disease , preoperative beta-adrenergic blocking agent therapy or P-wave duration . The incidence of AF was significantly lower ( p = 0.036 ) in the paced group ( 10 % ) compared with control subjects ( 27 % ) . Multivariate analysis showed AF incidence to increase with age ( p = 0.051 ) but not in patients with pacing ( p = 0.078 ) . It decreased with a better left ventricular ejection fraction only in conjunction with atrial pacing ( p = 0.018 ) . CONCLUSIONS We conclude that continuous atrial pacing with an algorithm for dynamic overdrive reduces significantly incidence of AF the second day after CABG surgery , particularly in patients with preserved left ventricular function OBJECTIVE The preventative effect of statins on  postoperative atrial fibrillation  has been hypothesized . However , all studies to date have examined patients who did not receive statins  before their further allocation to treatment or no treatment . Because guidelines recommend the routine use of statins in patients with coronary artery disease , we set out to examine the effect of intensive statin pretreatment versus continuation of usual statin dose on atrial fibrillation after cardiac surgery . METHODS Patients receiving routine statin treatment and undergoing coronary artery bypass surgery or aortic valve replacement with no history of atrial fibrillation or antiarrhythmic medication were r and omized to receive atorvastatin 80 mg or atorvastatin 10 mg for 7 days before surgery in a single-blind fashion . The primary end point was the development of postoperative atrial fibrillation during hospital stay . RESULTS A total of 104 consecutive patients were included . Postoperative atrial fibrillation occurred in 33 patients ( 32.4 % ) . No significant differences were found in demographics , medical history , or intraoperative variables between treatment groups , with the exception of higher rate of β-blocker use in the atorvastatin 10 mg group ( 75 % vs 53 % , P = .002 ) and previous myocardial infa rct ion ( 62 % vs 42 % , P = .049 ) . The incidence of postoperative atrial fibrillation was lower in the atorvastatin 80 mg group when compared with the atorvastatin 10 mg group , but this difference did not reach statistical significance ( 29 % vs 36 % , P = .43 ) . CONCLUSIONS High-dose atorvastatin for 7 days before cardiac surgery conferred a nonsignificant reduction in postoperative atrial fibrillation when compared with a low-dose regimen . A larger study would be necessary to confirm the beneficial effect of high-dose statins in this setting Background Preoperative anxiety and physical unfitness have been shown to have adverse effects on recovery from cardiac surgery . This study involving cardiac surgery patients was primarily aim ed at assessing the feasibility of delivering physical conditioning and stress reduction programs within the public hospital setting . Secondary aims were to evaluate the effect of these programs on quality of life ( QOL ) , rates of postoperative atrial fibrillation ( AF ) and length of stay ( LOS ) in hospital . Methods Elective patients scheduled for coronary artery bypass graft and /or valve surgery at a public hospital in Melbourne , Australia were enrolled . Patients were r and omized to receive either holistic therapy ( HT ) or usual care ( UC ) . HT consisted of a series of light physical exercise sessions together with a mental stress reduction program administered in an outpatient setting for the first two weeks after placement on the waiting list for surgery . A self-administered SF-36 question naire was used to measure QOL and hospital records to collect data on LOS and rate of postoperative AF . Results The study population comprised 117 patients of whom 60 received HT and 57 received UC . Both programs were able to be delivered within the hospital setting but ongoing therapy beyond the two week duration of the program was not carried out due to long waiting periods and insufficient re sources . HT , as delivered in this study , compared to UC did not result in significant changes in QOL , LOS or AF incidence . Conclusions Preoperative holistic therapy can be delivered in the hospital setting , although two weeks is insufficient to provide benefits beyond usual care on QOL , LOS or postoperative AF . Further research is now required to determine whether a similar program of longer duration , or targeted to high risk patients can provide measurable benefits .Trial registration This trial was conducted as part of a larger study and according to the principles contained in the CONSORT statement 2001 Background — Atrial fibrillation ( AF ) after coronary artery bypass graft surgery is a difficult problem and a continuing source of morbidity and mortality . However , the prognostic implication s of postoperative AF are still in dispute . Our aim was to ascertain the impact of AF after coronary artery bypass graft on postoperative survival and to assess its prognostic role in cause-specific mortality . Methods and Results — We conducted a prospect i ve observational study of 1832 patients undergoing isolated coronary artery bypass graft between January 2000 and December 2005 at 2 cardiac surgery centers in northern Italy . Patients affected by postoperative AF were identified and followed up until death or study end ( April 30 , 2007 ) . A total of 570 patients ( 31 % ) developed AF after coronary surgery  . Patients affected by postoperative AF experienced a longer hospital stay ( 7 days [ 25th to 75th percentile , 7 to 10 days ] versus 7 days [ 25th to 75th percentile , 6 to 8 days ] ; P<0.001 ) . Hospital mortality also was higher in AF patients ( 3.3 % versus 0.5 % ; P<0.001 ) . On discharge , 1806 patients were alive ; 143 were lost to follow-up . The remaining 1663 were followed up for a median of 51 months ( 25th to 75th percentile , 41 to 63 months ) ; 126 of them died after a median of 14 months ( 25th to 75th percentile , 5 to 32 months ) . Long-term mortality rates were significantly higher for patients with postoperative AF ( 2.99 per 100 person-years ; 95 % confidence interval , 2.33 to 3.84 ; 61 deaths ) compared with those without the arrhythmia ( 1.34 per 100 person-years ; 95 % confidence interval , 1.05 to 1.71 ; 65 deaths ) , with an adjusted hazard ratio of 2.13 ( P<0.001 ) and 2.56 ( P=0.001 ) when also accounting for the prescription of warfarin at discharge . With Cox regression , patients with AF were shown to be at higher risk of dying from embolism ( adjusted hazard ratio , 4.33 ; 95 % confidence interval , 1.78 to 10.52 ) but not from other causes . Conclusions — Postoperative AF affects early and late mortality after isolated coronary artery bypass graft surgery . Patients affected by AF are at higher risk of fatal embolic events . Careful postoperative surveillance with a specific antiarrhythmic and antithrombotic prophylaxis , aim ed at reducing AF and its complications , is recommended OBJECTIVE Atrial fibrillation is a common complication after cardiac surgery .  Magnesium is an effective and safe antiarrhythmic agent for arrhythmias that develop after cardiac surgery . The authors performed a study to evaluate the role of perioperative magnesium for prophylaxis of atrial fibrillation after off-pump coronary artery surgery . DESIGN R and omized controlled study . SETTING University teaching hospital . PARTICIPANTS One hundred sixty consecutive patients undergoing elective , isolated , off-pump coronary artery bypass grafting were prospect ively r and omized into 2 groups . INTERVENTIONS Patients in the magnesium group ( n = 80 ) received a 2.5-g ( 20 mEq ) magnesium sulphate infusion intraoperatively over 30 minutes , and the placebo group ( n = 80 ) received normal saline solution . MEASUREMENTS AND MAIN RESULTS Postoperative atrial fibrillation occurred in 16 of 80 patients ( 20 % ) in the magnesium group and in 18 of 80 ( 22.5 % ) in the placebo group ( p = 0.9 ) . CONCLUSION The use of 2.5 g of intraoperative magnesium showed no effect in preventing atrial fibrillation after off-pump coronary artery bypass Background —The Cox Maze procedure for treatment of medically refractory atrial fibrillation ( AF ) is limited by its complexity and requirement for cardiopulmonary bypass . Long-term follow-up and success using criteria established by the Heart Rhythm Society/European Heart Rhythm Association/European Cardiac Arrhythmia Society consensus statement have not been reported for surgical AF ablation . We describe the results of using a thorascopic approach and radiofrequency energy to perform bilateral pulmonary vein isolation and left atrial ganglionic plexi ablation for treatment of AF . Methods and Results —Forty-five ( 33 paroxysmal ; 12 persistent ) consecutive patients underwent thorascopic bilateral radiofrequency pulmonary vein isolation , ganglionic plexi ablation , ligament of Marshall ablation , and left atrial appendage exclusion by a single surgeon . Forty-three patients were prospect ively followed without antiarrhythmic drugs for a minimum of 1 year with a 30-day continuous event monitor or pacemaker interrogation at 6 and 12 months . Failure was defined as any atrial tachyarrhythmia of > 30 seconds ’ duration occurring > 90 days after surgery . Mean follow-up was 516±181 days ( 202 to 858 days ) . Twenty-eight ( 65 % ) patients had no atrial tachyarrhythmia > 30 seconds by 1 year , and 15 ( 35 % ) patients had atrial tachyarrhythmia recurrences by 1 year . Eight of 15 patients with recurrent AF had catheter ablation result ing in elimination and /or reduction of AF episodes in 7 of 8 patients . Four of 15 patients had AF elimination or reduction with antiarrhythmic drugs alone . Three patients did not benefit from surgery and received rate control only . There were no deaths ; 1 phrenic nerve injury and 2 pleural effusions were the only major complications . Conclusions —The single procedure success at 1-year follow-up for surgical pulmonary vein isolation and ganglionic plexi ablation is 65 % . Atrial tachyarrhythmia recurrences after surgery are usually responsive to catheter ablation and /or antiarrhythmic drugs BACKGROUND Coronary artery bypass graft and cardiac valve surgeries are frequently performed in medical facilities in the United States , and postoperative nausea ( PON ) is a prevalent problem in this patient population . The purpose of this study was to evaluate the efficacy of a single preoperative acupuncture treatment in the prevention of PON in patients undergoing coronary artery bypass graft or cardiac valve surgery , or both . METHODS Ninety participants presenting for coronary artery bypass graft or cardiac valve surgery , or both , were recruited for this study . Patients were r and omly assigned to receive either one preoperative acupuncture and st and ard postoperative care ( acupuncture group ) or solely st and ard postoperative care ( control group ) . Acupuncture was performed 0.5 to 3 hours before surgery . The PON incidence and severity on postoperative day ( POD ) 2 and POD 3 were measured with vali date d nausea tools . RESULTS The acupuncture group had a significantly lower incidence of nausea compared with the control group ( POD 2 , odds ratio [ OR ] , 0.38 ; p = 0.05 ; and POD 3 , OR , 0.26 ; p = 0.01 ) . The acupuncture group also had a significantly lower score of nausea severity than the control group ( POD 2 , OR , 0.29 ; p = 0.01 ; and POD 3 , OR , 0.25 ; p = 0.01 ) . No adverse effects due to acupuncture treatment were reported . Antiemetics , pain medications , and anesthetics administered intraoperatively did not differ between the two groups and did not influence study results . CONCLUSIONS A single preoperative acupuncture treatment decreased incidence and severity of PON in patients undergoing coronary artery bypass graft or cardiac valve surgery , or both , and caused no adverse effects OBJECTIVES To determine whether restarting of Beta Blocker following cardiac surgery would reduce the incidence and the severity of post-operative atrial fibrillation ( AF ) . METHODS 210 patients who underwent elective coronary artery bypass grafting were r and omized to control ( C ) ( n = 105 ) and Beta Blockers ( BB ) ( n = 105 ) groups . Preoperatively all patients were on one type or another of betablockers . Postoperatively only the ( BB ) group received the medication . Both groups were well matched and had the same cardioplegic technique . RESULTS It was found that ; ( 1 ) post op ( AF ) developed in 40 patients of group ( C ) and in 18 patients of group ( BB ) P value < 0.02 . ( 2 ) 73 % of ( AF ) patients in group ( C ) and 81 % in group ( BB ) were older than 70 years of age . ( 3 ) 76 % of the ( AF ) in ( BB ) group versus 43 % in ( C ) group were converted to sinus rhythm or to a stable controlled rhythm within 24 h or less . P value < 0.01 . CONCLUSIONS The results indicate that restarting the Beta Blockers in the post-operative period after coronary bypass grafts significantly control the incidence and the severity of atrial fibrillation . Also it confirms the strong relation between the older age and ( AF ) occurrence The neutrophil/lymphocyte ( N/L ) ratio integrates information on the inflammatory milieu and physiologic stress . It is an emerging marker of prognosis in patients with cardiovascular disease . We investigated the relation between the N/L ratio and postoperative atrial fibrillation ( AF ) in patients undergoing coronary artery bypass grafting .  In a prospect i ve cohort study , 275 patients undergoing nonemergency coronary artery bypass grafting were recruited . Patients with previous atrial arrhythmia or requiring concomitant valve surgery were excluded . The N/L ratio was determined preoperatively and on postoperative day 2 . The study end point was AF lasting > 30 seconds . Patients who developed AF ( n = 107 , 39 % ) had had a greater preoperative N/L ratio ( median 3.0 vs 2.4 , p = 0.001 ) , but no differences were found in the other white blood cell parameters or C-reactive protein . The postoperative N/L ratio was greater in patients with AF ( day 2 , median 9.2 vs 7.2 , p < 0.001 ) , and in multivariate models , a greater postoperative N/L ratio was independently associated with a greater incidence of AF ( odds ratio 1.10 per unit increase , p = 0.003 : odds ratio for N/L ratio > 10.14 [ optimal postoperative cutoff in our cohort ] , 2.83 per unit , p < 0.001 ) . Elevated pre- and postoperative N/L ratios were associated with an increased occurrence of AF after coronary artery bypass grafting . In conclusion , these results support an inflammatory etiology in postoperative AF but suggest that other factors are also important
Results The consensus panel agreed on the following statements in patients with AF undergoing cardiac surgery concomitant surgical ablation : 1 .
Improves the achievement of sinus rhythm at discharge and 1 year ( level A ) ; this effect is sustained up to 5 years ( level B ) .
2 .
3 .
Does not increase the risk of perioperative mortality ( level A ) , stroke ( level A ) , myocardial infa rct ion ( level B ) , cardiac tamponade ( level A ) , reoperative bleeding ( level A ) , esophageal injury ( level B ) , low cardiac output ( level A ) , intraaortic balloon ( level B ) , congestive heart failure ( level B ) , ejection fraction ( EF ; level B ) , pleural effusion ( level A ) , pneumonia ( level A ) , renal dysfunction ( level B ) , and mediastinitis ( level A ) .
The incidence of esophageal injury remains to be low ( level B ) .
4 .
Does not reduce mortality at 1 year ( level A ) .
5 .
6 .
Increases cardiopulmonary bypass and cross-clamp times ( level A ) , with no difference in intensive care unit and hospital length of stay ( level A ) .
Conclusions Given these evidence -based statements , the consensus panel stated that , in patients with persistent and permanent AF undergoing cardiac surgery , concomitant surgical ablation is recommended to increase incidence of sinus rhythm at short- and long-term follow-up ( class 1 , level A ) ; to reduce the risk of stroke and thromboembolic events ( class 2a , level B ) ; to improve EF ( class 2a , level A ) ; and to exercise tolerance ( class 2a , level A ) and long-term survival ( class 2a , level B )
Objective This purpose of this consensus conference was to determine whether surgical atrial fibrillation ( AF ) ablation during cardiac surgery improves clinical and re source outcomes compared with cardiac surgery alone in adults undergoing cardiac surgery for valve or coronary artery bypass grafting .