Pii: S1010-7940(01)00725-4

Objective: Atrial ®brillation (AF) is common after coronary artery bypass graft (CABG) surgery. Atrial ischaemia due to diseased atrioventricular (AV) and sinoatrial (SA) arteries has been proposed as a cause of AF post-CABG. We examined if the presence of diseased nodal arteries was a signi®cant predictor of the development of AF post-CABG. Methods: 100 consecutive cases (AF post-CABG) were compared to 100 consecutive controls (No AF post-CABG) with respect to pre-operative angiographic evidence of diseased nodal arteries. Cases and controls identi®ed from the Society of Thoracic Surgeons database underwent detailed chart reviews to obtain data on potential risk factors. Patients were excluded if they were undergoing anything but a routine CABG procedure, were older than 65 years, or had previous AF. All angiograms were reviewed by a single radiologist blinded to outcome. The effect of grafting diseased nodal arteries on the development of AF post-CABG was also measured. A multiple logistic regression model was utilized to measure the effect of disease in each artery on the development of AF post-CABG. Results: Cases and controls were comparable regarding potential risk factors, with the exception that the AF group was older than the non-AF group. Signi®cant AV artery disease was detected in 78 cases compared to 74 controls (adjusted odds ratio (OR) OR ˆ 1:04, CI, 0.51±2.12, P ˆ 0:82). Signi®cant SA artery disease was detected in 34 cases compared to 21 controls (adjusted OR ˆ 2:093, CI: 1.06±4.09, P ˆ 0:03). Six of ten patients having revascularization of their SA nodal artery developed AF versus 28 of 45 of those who did not (OR ˆ 0:91, CI: 0.18±5.06, P ˆ 0:58). Forty-eight of 87 patients having revasacularization of their AV nodal artery developed AF versus 30 of 65 of those who did not (OR ˆ 1:44, CI: 0.72±2.88, P ˆ 0:27). Conclusion: The presence of a diseased SA artery is signi®cantly associated with AF post-CABG. Such association may be used to identify a subset of patients who might be targeted with prophylaxis. q 2001 Elsevier Science B.V. All rights reserved.