New light shed on atrial fibrillation after bypass surgery

DURHAM, N.C. -- An analysis of 4,657 patients undergoing coronary artery bypass surgery has shown that discontinuing certain heart medications such as beta blockers and ACE inhibitors can lead to abnormal accelerations in heart pumping known as atrial fibrillation, while those and other agents can offer protection.

Since an estimated one in three bypass patients will suffer at least one episode of atrial fibrillation in the days and weeks following surgery, these and additional findings from a new international study have important clinical implications, said principal investigator and Duke anesthesiologist Joseph Mathew, M.D.. Past studies have shown that atrial fibrillation can lead to heart failure, kidney damage or stroke, and can prolong hospitalization after surgery while the irregular heart rhythm is controlled.

The researchers also found that more than 40 percent of patients who experience atrial fibrillation after surgery have more than one episode, and that it is these patients who are responsible for the bulk of increased complications and lengthened hospital stays.

According to the researchers, no large-scale international study has systematically evaluated the pre-operative risk factors for atrial fibrillation, as well as the potential risk factors during surgery and during the recovery period after surgery. The results of the first such analysis were published March 14, 2004, in the Journal of the American Medical Association.

"Based on the results of our analysis, we now have a risk index that should be better able to not only predict which heart surgery patients are at higher risk for atrial fibrillation, but what actions we can take to prevent it from occurring," Mathew said. "The incidence of atrial fibrillation has remained fairly constant over the past two decades; we hope this new risk index can improve outcomes for bypass surgery patients."

Atrial fibrillation arises from abnormal electrical discha

Contact: Richard Merritt
Duke University Medical Center

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