Atrial fibrillation after off-pump versus on-pump coronary artery bypass graft surgery

Atrial fibrillation [AF] is the most common postoperative arrhythmic complication after coronary artery bypass graft surgery [CABG]. The aim of the present study was to compare AF prevalence after off-pump versus on-pump CABG. In this prospective study, performed between September 2008 and September 2009, 128 consecutive patients in our local cardiovascular surgery ward were allocated into two groups of off-pump [95 patients] and on-pump CABG [33 cases]. We compared preoperative risk factors such as left ventricular ejection fraction [LVEF]<%40, hypertension [HTN], and Cr>2mg/dl, site of grafting such as the left coronary descending artery [LAD], right coronary artery [RCA], and left circumflex artery [LCX] in the two groups of surgery techniques [on-pump versus off-pump CABG] with/without postoperative AF after 24 hours of surgery in the Intensive Care Unit, Statistical power of the study was 80%, and a P-value less than 0.05 was considered significant. The prevalence of AF was 15 [15.8%] in the off-pump group versus 7 [21.2%] in the on-pump group [p=0.67] 24 hours after CABG. In the on-pump group, there was no difference between age categories [p=0.11]. In the on-pump group, as opposed to the off-pump CABG group, there was no relationship between the surgery techniques with or without AF, LVEF <%40, and HTN. There was a significant relation with Cr more than 2 mg/dl in the on-pump CABG group [p=0.001] versus the off-pump CABG group [p=0.057]. There was no statistical relation between the type of vascular graft [LAD, RCA, and LCX] between the on-pump and off-pump CABG patients attributed to with or without AF. There was no reduction in the AF rate in the off and on-pump CABG versus off-pump CABG. It seems that there was another predictive factor for AF in the off and on-pump CABG groups, so further prospective trials with larger sample sizes are recommended

Incessant ventricular tachycardia acutely controlled with off-pump coronary artery bypass surgery and aneurysmal plication

There are many treatment modalities available to acutely terminate incessant ventricular tachycardia with variable success rates, but some cases tend to prove refractory to all of them. We report a 59-year-old woman presenting with incessant ventricular tachycardia. Echocardiography revealed a large true apical aneurysm and severe left ventricular dysfunction. The arrhythmia was controlled in the operating room after off-pump coronary artery bypass surgery and plication of the apical aneurysm