Can off-pump coronary artery bypass graft surgery decrease the incidence of postoperative atrial fibrillation?

Background: Atrial fibrillation (AF) remains the most common cardiac arrhythmia encountered after coronary artery bypass grafting (CABG) and leads to a significant source of morbidity and mortality after the surgery. Due to its involving less manipulation of the atria, off-pump CABG was thought to have a lower incidence of postoperative AF compared with on-pump CABG. Methods: Two hundred and twenty-five patients (154 male) underwent CABG. Preoperative permanent AF patients were excluded (n = 12). Group 1 consisted of 78 patients (53 male, 68.6 ± 11.9 years old; 25 female, 70.7 ± 7.9 years old) who received off-pump CABG, and group 2 included 135 patients (93 male, 72.1 ± 10.1 years old; 42 female, 72.3 ± 7.9 years old) who underwent on-pump CABG with cardiopulmonary bypass (CPB) during the same study period. The incidence and predictors of postoperative AF were analyzed. Results: AF developed in 60 cases (28.2%) after CABG. There were higher incidence of myocardial infarction, history of paroxysmal atrial fibrillation, NYHA Fc ≧ 2, β-blocker use, and longer intubation in the on-pump group compared with the off-pump group. However, there was no significant difference relating to the incidence of AF between off-pump (23.1%) and on-pump (31.1%) groups. The predictors of AF were old age (> 65 years, OR: 5.008, 95% CI: 1.4-17.9, p = 0.013), history of paroxysmal AF (OR: 7.851, 95% CI: 2.4-25.6, p = 0.001) and prolonged postoperative intubation days (> 3 days, OR: 5.303, 95% CI: 2.2-13.1, p <0.001). Conclusion: In this retrospective study, off-pump CABG surgery did not decrease the incidence of postoperative AF.