Abstract
It is assumed that stenosis of the right coronary artery (RCA) predisposes CABG patients,
by way of incomplete atrial myocardial protection, to postoperative atrial fibrillation
(AF). Sixty patients with high-grade RCA lesion were randomized into four groups according
to the technique of delivery of cold blood cardioplegia: antegrade, retrograde, retrograde
without catheter cuff, and combined antegrade and retrograde. As controls, 34 patients
without RCA lesion were randomized to receive antegrade or retrograde cardioplegia.
Postoperative atrial fibrillation episodes were recorded. Patients with RCA lesion
were more prone to develop AF; odds ratio (OR) = 3.75 (95% confidence interval [CI]
= 1.22-11.5). Retrograde delivery in these patients was more often associated with
AF, OR = 4.97 (95% CI = 1.02-24.1). Other risk factors for AF were an increasing number
of preoperative infarcts (p < 0.05) and more advanced coronary artery disease (p <
0.05). Prolonged stay in the intensive care unit (p < 0.001) and occurrence of postoperative
ventricular tachycardia (p < 0.05) were associated with AF. RCA stenosis and retrograde
cardioplegia delivery in RCA-affected patients were risk factors for postoperative
atrial fibrillation. Retrograde cardioplegia may offer poorer protection at the atrial
level.
Key words
Atrial fibrillation - Myocardial protection - CABG surgery
