DOES TYPE OF CARDIOPLEGIA AFFECT THE INCIDENCE OF POSTOPERATIVE PAROXYSMAL ATRIAL FIBRILLATION IN PATIENTS UNDERGOING CARDIAC SURGERY?

Abstract Background and Aim: Paroxysmal atrial fibrillation (PAF) is the most frequent complication following cardiac surgery. Despite high incidence, its etiology remains uncler. Aim of our investigation was to analyze retrospectively the pathogenetic role of different types of cardioplegia on the onset of PAF. Methods: Sixty-hundred and sixty patients underwent on-pump cardiac surgery between January 2015 and October 2016. Redo operations and emergency surgery were excluded. The types of cardiolplegic solution administered were warm blood cardioplegia (Calafiore, n = 480), cold crystalloid extracellular cardioplegia (St. Thomas, n = 71), cold crystalloid intracellular cardioplegia (Custodiol, n = 109). The way of admistation was antegrade for all types of cardioplegic solution. Results: The incidence of postoperative PAF was 36.2% (239 patients). Two-hundred patients were initially treated by mens of amiodarone infusion that successfully allowed cardioversion in 167 cases (83.5%); in the other 39 patients were initially administered other drugs (i.e. verapamil e.v./per os, beta-blokers per os). A relation between the type of cardioplegic solution and the onset of postoperative PAF was not found (Calafiore, n = 180, 37.5%; St. Thomas, n = 22, 31%; Custodiol, n = 37, 34%; p = NS). Advanced age at operation (71.3 ± 8.7 vs. 65.7 ± 11 years) was the only independent predictor of PAF (p < 0.001). Non-coronary surgery was found as risk factor for PAF at the univariate analysis only (p < 0.01). Conclusions: The use of different type of cardioplegic solutions, and at different temperatures, does not correlate with the onset of postoperative PAF. Initial treatment strategy with amiodarone infusion allows pharmacological cardioversion of PAF in over 80% of cases.