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O-76 Influence of thoracic epidural anaesthesia on haemodynamic changes
S32
FREE ORAL SESSIONS
postoperative management were standardized. Endpoints were changes of intra-thoracic blood index (⌬ITBI), extra-lung water index (⌬ELWI), pulmonary vascular permeability index (⌬PVPI), ventilation time, serum sodium concentration. Mann-Whitney U-test was used to evaluate the differences between groups. P⬍0.05 was considered significant. Results. Incidence of complications was 2 (25%) and 3 (37.5%) for neurologic event and acute kidney injury (AKI) respectively in the experimental group. There was no neurologic event and 1 case (14.3%) of AKI in the control group. Haemodynamics, ⌬ITBI, ⌬ELWI, ⌬PVPI, fluid balance, ventilation time were not different between groups. The HyperHAES group showed elevated levels of serum sodium concentration compared to control at all the time points from 4 h to 48 h postoperatively (P⬍0.05). Discussion. The study was prematurely terminated due to a high incidence of complications in the group being studied. Our current investigation reveals no benefits from using hyperosmotic-hyperoncotic solution in patients undergoing valve replacement. A relatively high rate of complications seen in the HyperHAES group should raise caution in using this solution and promote further investigations of its effects. REFERENCE 1. Azoubel G, Nascimento B, Ferri M, et al. Operating room use of hypertonic solutions: a clinical review. Clinics (Sao Paulo) 2008; 63: 833-40. Review. O-75 Effects of prolonged nutritional support on liver enzymes in patients undergoing open heart surgery Buket Ozyaprak, Ayse Baysal, Ismail Ozkaynak, Tuncer Kocak Kartal Kosuyolu Training and Research Hospital, Kartal, Istanbul, Turkey Introduction. The effects of prolonged nutritional support on liver function tests (LFTs) in patients with congestive heart failure who underwent open heart surgery (coronary artery bypass graft (CABG) or valve repair surgery) that required prolonged mechanical ventilation and nutritional support were investigated. Method. Sixty patients with signs of congestive heart failure and an ejection fraction below 40%, undergoing open heart surgery, were investigated. 31 patients (51%) had CABG and 29 (49%) had valve repair surgery. All patients received enteral and total parenteral nutrion for a period of 15 days. The collected data preoperatively and on postoperative day 1, 7 and 14 included albumin (Alb), alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), total bilirubin (TBIL) and gamma glutamyl transpeptidase (GGT). Complications were recorded. Parameters ALP*(mg/dL) AST*(mg/dL) ALT*(mg/dL) LDH*(mg/dL) TotalBilirubin (mg/dL) GGT*(mg/dL)
Day 1
Day 7
Day 14
Day 1-14 P*
107.9 ⫾ 37.5 65.7 ⫾ 38.3 37.8 ⫾ 24.9 765.0 ⫾ 227.7 1.0 ⫾ 0.5
98.9 ⫾ 37.1 55.6 ⫾ 31.3 38.6 ⫾ 28.0 782.6 ⫾ 298.8 1.1 ⫾ 0.5
96.3 ⫾ 45.3 55.2 ⫾ 37.6 35.5 ⫾ 3.8 700.3 ⫾ 268.7 1.1 ⫾ 0.5
0.03* 0.02* 0.34 0.02* 0.20
51.5 ⫾ 33.5
53.4 ⫾ 35.7
61.3 ⫾ 40.1
0.03*
*P: P⬍0.05 statistically significant; CABG; coronary artery bypass graft; alanine transaminase (ALT); aspartate transaminase (AST); alkaline phosphatase (ALP); lactate dehydrogenase (LDH); total bilirubin (TBIL) and gamma glutamyl transpeptidase (GGT).
Results. The comparison of LFTs on day 1, 7 and 14 revealed that plasma ALP, AST and LDH levels decreased on day 14 compared to day 1 (P ⫽ 0.03 and P ⫽ 0.02, P ⫽ 0.02 respectively). Total bilirubin levels did not show any change whereas GGT levels showed some elevation in comparison to day 1 levels (P ⫽ 0.03) (Table 1). Postoperatively, the ultrasonographic study of liver and gallbladder of 3 patients (5%) who underwent CABG procedure showed sludge and/ or calculi. Conclusion. After open heart surgery, in patients with congestive heart failure and low ejection fraction, prolonged nutritional support does not cause deterioration in the liver function tests. However, further investigation for detection of gallbladder dysfunction may be needed. O-76 Influence of thoracic epidural anaesthesia on haemodynamic changes Tadas Lenkutis, Edmundas Sirvinskas Lithuanian University of Health Sciences, Kaunas, Lithuania Introduction. Despite epidural anaesthesia alone and in combination with general anaesthesia having been widely applied already for many years in different surgery fields, its benefits in on-pump cardiac surgery is still under discussion [1]. Advantage of a thoracic epidural anaesthesia is purportedly clear with effective suppression of post-operative pain, stress and inflammatory reactions. However thoracic epidural anaesthesia directly influences the circulation causes haemodynamic instability and the patient’s need for an increased preload [2]. The aim of the study was to determine the impact of thoracic epidural anaesthesia on the cardiovascular system using a transpulmonary thermodilution technique, during on-pump surgery. Method. Sixty patients undergoing coronary artery bypass graft surgery were enrolled in the study. They were randomized into two groups: anaesthesia group (GA, n ⫽ 30) and epidural anaesthesia group (TEA, n ⫽30) having general anaesthesia with TEA. Haemodynamic monitoring was conducted using PiCCO system. Baseline measurements of SI, global end-diastolic volume index (GEDI), intrathoracic blood volume index (ITBVI) were recorded in all patients before fluid load. An iv. fluid load of 6 –7 ml/kg of Ringer’s lactate was infused to all patients before induction. In the TEA group, an epidural catheter was positioned in T1-T2 interspace. Lidocaine 2% 7– 8 ml was injected into epidural catheter and followed by an infusion of 0.25% bupivacaine 8-10 ml/h for 2 hours. Induction of general anaesthesia was the same in both groups. Anaesthesia was maintained with sevoflurane and iv. midazolam in both groups. Iv. fentanyl 10 –12 g/kg was used as an analgesic component in the GA group and epidural bupivacaine infusion in the TEA group. Mean ABP was maintained in all patients between 50 and 75 mmHg by infusion of iv. fluids and by administration of vasoconstrictors. SI, ITBVI, and GEDI measurements were made before anaesthesia (baseline measurement), 20 min after start of surgery, 20 min, 60 min, 180 min, 600 min and 24 hr after cardiopulmonary bypass (CPB). Student’s t-test was used for comparison of the analysed variable averages and the data are presented as mean ⫾ EM. P⬍0.05 was considered statistically significant. Results. There were no significant differences in baseline in all measurements between two groups. During TEA, SI and GEDI were significantly higher at all points of measurement compared
FREE ORAL SESSIONS
with GA. Fluid balance was higher in TEA group 2,833⫾42.44 ml, vs. GA 2,540⫾42.5 (P⬍0.001). Conclusion. Thoracic epidural anaesthesia during on-pump cardiac surgery significantly increases SI throughout surgery and the early post-operative period by increaseof GEDI. REFERENCES 1. Royse C. F. High thoracic epidural anaesthesia for cardiac surgery. Curr Opin Anaesth 2009; 22: 84-7. 2. Stenseth R, Bjella L, Berg E. M, et al. Thoracic epidural analgesia in aortocoronary bypass surgery I: haemodynamic effects. Acta Anaesth Scand 2008; 38: 826-33. O-77 Levosimendan versus intra-aortic balloon pump in high risk cardiac patients operated under cardiopulmonary bypass: a pilot study Vladimir Lomivorotov, Vladimir Boboshko, Alexander Cherniavskiy, Igor Kornilov, Vladimir Shmirev, Ljubov Knyazkova Research Institute of Circulation Pathology, Novosibirsk, Russia Introduction. The choice of a method of haemodynamic support in patients with low ejection fraction of the left ventricle (LVEF) is the crucial moment in the management of high risk cardiac patients. The purpose of our study was to compare the efficiency of levosimendan and intra-aortic balloon pump (IABP) in high risk patients (LVEF⬍35%) operated under cardiopulmonary bypass (CPB). Method. From August 2009 to September 2010 40 patients with coronary artery disease, operated under CPB were randomized in two groups. In the first group levosimendan (L) infusion (0.1 mcg·kg1·min-1 for 24 hours with initial 12 mcg·kg-1 bolus) was started after anaesthesia induction. In the second group IABP was started one day before surgery. Groups were comparable in preoperative status, duration of CPB and number of graft performed. The level of troponin-I and haemodynamics (thermodilution technique) were assessed perioperatively. Blood loss, duration of ventilation, need for inotropic support, rate of complications and intensive care unit (ICU) stay were also analysed. Data are presented as mean⫾SD, P⬍0.05 was considered to be significant. Results. Cardiac index (CI) in the L group was significantly higher from 5 min after CPB to 6 hours postoperatively compared to the IABP group. The increase of CI in the L group was accompanied by an increase in stroke index 30 min after CPB (32.0⫾8.9 vs. 28.7⫾4.8 ml·m-2, P⬍0.05) and at the end of operation (31.5⫾9.7 vs. 27.3⫾4.6 ml·m-2, P⬍0.05) There were no differences between groups in the duration of ventilation and rate of complications. The level of troponin-I 6 hours after operation was lower in the L group (2.74⫾2.0 vs. 6.7⫾5.9 respectively, P⬍0.05). Duration of ICU-stay was significantly lower in the L group. Conclusion. The use of L in high risk cardiac patients is superior to IABP in terms of maintaining stable haemodynamics during and after operation under CPB and reduction of ICU-stay. Low level of troponin-I 6 hours after the operation suggests cardioprotective properties of levosimendan. O-78 Anaesthetic techniques and transcatheter aortic valve implantation Marina Balanika, Anna Smyrli, Sofia Thomopoulou, Kostas Spargias, Vassilis Voudris, Stavroula Lacoumenta
S33
Onassis Cardiac Surgery Centre, Athens, Greece
Introduction. Transcatheter aortic valve implantation is an alternative therapeutic option for patients with severe aortic stenosis who are not considered as candidates for a conventional aortic valve replacement. The aim of this study was to evaluate the influence of the anaesthetic technique on the perioperative course and the postoperative outcome. Method. We reviewed the records of 98 patients who underwent a transcatheter aortic valve implantation. Patients were divided into two groups I and II. Group I received general anaesthesia (GA) while Group II monitored anaesthesia care (MAC). The following parameters were studied: anaesthesia and procedure duration, number of transfusions, cardiac index and superior vena caval saturation (ScVO2) before and after the aortic valve implantation, hospital length of stay and 30 day mortality. Statistical analysis was performed using Mann-Whitney U-test (P⬍0.05 was considered significant). Results. There were no statistically significant differences between the groups as far as the demographic data and all the other parameters studied are concerned with the exception of the duration anaesthesia and the ScVO2 value. Anaesthesia duration was significantly prolonged when general anaesthesia was administered (171.5⫾55.3 vs. 115.2⫾29.3 minutes, P⬍0.001). The ScVO2 was significantly higher both before (77.8⫾6.0 vs. 72.8⫾6.6, P⬍0.05) and after (79.2⫾6.1 vs. 75.3⫾5.9, P⬍0.05) the valve implantation in the same group of general anaesthesia. Conclusion. It seems that both anaesthesia techniques appear to be equally feasible and safe for these patients with a high logistic EuroSCORE. Increased ScVO2 value in Group I was due to higher PaO2 levels during general anaesthesia. [1] REFERENCE 1. Guinot PG, Depoix JP, Etchegoyen L, et al. Anesthesia and perioperative management of patients undergoing transcatheter aortic valve implantation: analysis of 90 consecutive patients with focus on perioperative complications. J Cardiothorac Vasc Anesth 2010; 24: 752-61. O-79 Preoperative statin treatment and postoperative atrial fibrillation (AF) in patients undergoing coronary surgery: a retrospective cohort study Paola Moliterni, Gabriele Nora Piazzoni, Erminio Sisillo
Papagni,
Cristina
Beverini,
Centro Cardiologico Monzino IRCCS, Milana, Italy Introduction. The purpose of the present study was to assess the preventive effect of preoperative statin treatment on the incidence of atrial fibrillation (POAF) during the first 48 postoperative hours in patients undergoing isolated, first time, coronary artery bypass grafting (CABG). Method. Data from patients in normal sinus rhythm (NSR) submitted to CABG between 2008 and 2010 were collected from our clinical database and reviewed for differences in incidence of AF (episodes of FA lasting ⬎10 minutes and registered by the monitoring system). Patients were divided into two groups: pa-
FREE ORAL SESSIONS
postoperative management were standardized. Endpoints were changes of intra-thoracic blood index (⌬ITBI), extra-lung water index (⌬ELWI), pulmonary vascular permeability index (⌬PVPI), ventilation time, serum sodium concentration. Mann-Whitney U-test was used to evaluate the differences between groups. P⬍0.05 was considered significant. Results. Incidence of complications was 2 (25%) and 3 (37.5%) for neurologic event and acute kidney injury (AKI) respectively in the experimental group. There was no neurologic event and 1 case (14.3%) of AKI in the control group. Haemodynamics, ⌬ITBI, ⌬ELWI, ⌬PVPI, fluid balance, ventilation time were not different between groups. The HyperHAES group showed elevated levels of serum sodium concentration compared to control at all the time points from 4 h to 48 h postoperatively (P⬍0.05). Discussion. The study was prematurely terminated due to a high incidence of complications in the group being studied. Our current investigation reveals no benefits from using hyperosmotic-hyperoncotic solution in patients undergoing valve replacement. A relatively high rate of complications seen in the HyperHAES group should raise caution in using this solution and promote further investigations of its effects. REFERENCE 1. Azoubel G, Nascimento B, Ferri M, et al. Operating room use of hypertonic solutions: a clinical review. Clinics (Sao Paulo) 2008; 63: 833-40. Review. O-75 Effects of prolonged nutritional support on liver enzymes in patients undergoing open heart surgery Buket Ozyaprak, Ayse Baysal, Ismail Ozkaynak, Tuncer Kocak Kartal Kosuyolu Training and Research Hospital, Kartal, Istanbul, Turkey Introduction. The effects of prolonged nutritional support on liver function tests (LFTs) in patients with congestive heart failure who underwent open heart surgery (coronary artery bypass graft (CABG) or valve repair surgery) that required prolonged mechanical ventilation and nutritional support were investigated. Method. Sixty patients with signs of congestive heart failure and an ejection fraction below 40%, undergoing open heart surgery, were investigated. 31 patients (51%) had CABG and 29 (49%) had valve repair surgery. All patients received enteral and total parenteral nutrion for a period of 15 days. The collected data preoperatively and on postoperative day 1, 7 and 14 included albumin (Alb), alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), total bilirubin (TBIL) and gamma glutamyl transpeptidase (GGT). Complications were recorded. Parameters ALP*(mg/dL) AST*(mg/dL) ALT*(mg/dL) LDH*(mg/dL) TotalBilirubin (mg/dL) GGT*(mg/dL)
Day 1
Day 7
Day 14
Day 1-14 P*
107.9 ⫾ 37.5 65.7 ⫾ 38.3 37.8 ⫾ 24.9 765.0 ⫾ 227.7 1.0 ⫾ 0.5
98.9 ⫾ 37.1 55.6 ⫾ 31.3 38.6 ⫾ 28.0 782.6 ⫾ 298.8 1.1 ⫾ 0.5
96.3 ⫾ 45.3 55.2 ⫾ 37.6 35.5 ⫾ 3.8 700.3 ⫾ 268.7 1.1 ⫾ 0.5
0.03* 0.02* 0.34 0.02* 0.20
51.5 ⫾ 33.5
53.4 ⫾ 35.7
61.3 ⫾ 40.1
0.03*
*P: P⬍0.05 statistically significant; CABG; coronary artery bypass graft; alanine transaminase (ALT); aspartate transaminase (AST); alkaline phosphatase (ALP); lactate dehydrogenase (LDH); total bilirubin (TBIL) and gamma glutamyl transpeptidase (GGT).
Results. The comparison of LFTs on day 1, 7 and 14 revealed that plasma ALP, AST and LDH levels decreased on day 14 compared to day 1 (P ⫽ 0.03 and P ⫽ 0.02, P ⫽ 0.02 respectively). Total bilirubin levels did not show any change whereas GGT levels showed some elevation in comparison to day 1 levels (P ⫽ 0.03) (Table 1). Postoperatively, the ultrasonographic study of liver and gallbladder of 3 patients (5%) who underwent CABG procedure showed sludge and/ or calculi. Conclusion. After open heart surgery, in patients with congestive heart failure and low ejection fraction, prolonged nutritional support does not cause deterioration in the liver function tests. However, further investigation for detection of gallbladder dysfunction may be needed. O-76 Influence of thoracic epidural anaesthesia on haemodynamic changes Tadas Lenkutis, Edmundas Sirvinskas Lithuanian University of Health Sciences, Kaunas, Lithuania Introduction. Despite epidural anaesthesia alone and in combination with general anaesthesia having been widely applied already for many years in different surgery fields, its benefits in on-pump cardiac surgery is still under discussion [1]. Advantage of a thoracic epidural anaesthesia is purportedly clear with effective suppression of post-operative pain, stress and inflammatory reactions. However thoracic epidural anaesthesia directly influences the circulation causes haemodynamic instability and the patient’s need for an increased preload [2]. The aim of the study was to determine the impact of thoracic epidural anaesthesia on the cardiovascular system using a transpulmonary thermodilution technique, during on-pump surgery. Method. Sixty patients undergoing coronary artery bypass graft surgery were enrolled in the study. They were randomized into two groups: anaesthesia group (GA, n ⫽ 30) and epidural anaesthesia group (TEA, n ⫽30) having general anaesthesia with TEA. Haemodynamic monitoring was conducted using PiCCO system. Baseline measurements of SI, global end-diastolic volume index (GEDI), intrathoracic blood volume index (ITBVI) were recorded in all patients before fluid load. An iv. fluid load of 6 –7 ml/kg of Ringer’s lactate was infused to all patients before induction. In the TEA group, an epidural catheter was positioned in T1-T2 interspace. Lidocaine 2% 7– 8 ml was injected into epidural catheter and followed by an infusion of 0.25% bupivacaine 8-10 ml/h for 2 hours. Induction of general anaesthesia was the same in both groups. Anaesthesia was maintained with sevoflurane and iv. midazolam in both groups. Iv. fentanyl 10 –12 g/kg was used as an analgesic component in the GA group and epidural bupivacaine infusion in the TEA group. Mean ABP was maintained in all patients between 50 and 75 mmHg by infusion of iv. fluids and by administration of vasoconstrictors. SI, ITBVI, and GEDI measurements were made before anaesthesia (baseline measurement), 20 min after start of surgery, 20 min, 60 min, 180 min, 600 min and 24 hr after cardiopulmonary bypass (CPB). Student’s t-test was used for comparison of the analysed variable averages and the data are presented as mean ⫾ EM. P⬍0.05 was considered statistically significant. Results. There were no significant differences in baseline in all measurements between two groups. During TEA, SI and GEDI were significantly higher at all points of measurement compared
FREE ORAL SESSIONS
with GA. Fluid balance was higher in TEA group 2,833⫾42.44 ml, vs. GA 2,540⫾42.5 (P⬍0.001). Conclusion. Thoracic epidural anaesthesia during on-pump cardiac surgery significantly increases SI throughout surgery and the early post-operative period by increaseof GEDI. REFERENCES 1. Royse C. F. High thoracic epidural anaesthesia for cardiac surgery. Curr Opin Anaesth 2009; 22: 84-7. 2. Stenseth R, Bjella L, Berg E. M, et al. Thoracic epidural analgesia in aortocoronary bypass surgery I: haemodynamic effects. Acta Anaesth Scand 2008; 38: 826-33. O-77 Levosimendan versus intra-aortic balloon pump in high risk cardiac patients operated under cardiopulmonary bypass: a pilot study Vladimir Lomivorotov, Vladimir Boboshko, Alexander Cherniavskiy, Igor Kornilov, Vladimir Shmirev, Ljubov Knyazkova Research Institute of Circulation Pathology, Novosibirsk, Russia Introduction. The choice of a method of haemodynamic support in patients with low ejection fraction of the left ventricle (LVEF) is the crucial moment in the management of high risk cardiac patients. The purpose of our study was to compare the efficiency of levosimendan and intra-aortic balloon pump (IABP) in high risk patients (LVEF⬍35%) operated under cardiopulmonary bypass (CPB). Method. From August 2009 to September 2010 40 patients with coronary artery disease, operated under CPB were randomized in two groups. In the first group levosimendan (L) infusion (0.1 mcg·kg1·min-1 for 24 hours with initial 12 mcg·kg-1 bolus) was started after anaesthesia induction. In the second group IABP was started one day before surgery. Groups were comparable in preoperative status, duration of CPB and number of graft performed. The level of troponin-I and haemodynamics (thermodilution technique) were assessed perioperatively. Blood loss, duration of ventilation, need for inotropic support, rate of complications and intensive care unit (ICU) stay were also analysed. Data are presented as mean⫾SD, P⬍0.05 was considered to be significant. Results. Cardiac index (CI) in the L group was significantly higher from 5 min after CPB to 6 hours postoperatively compared to the IABP group. The increase of CI in the L group was accompanied by an increase in stroke index 30 min after CPB (32.0⫾8.9 vs. 28.7⫾4.8 ml·m-2, P⬍0.05) and at the end of operation (31.5⫾9.7 vs. 27.3⫾4.6 ml·m-2, P⬍0.05) There were no differences between groups in the duration of ventilation and rate of complications. The level of troponin-I 6 hours after operation was lower in the L group (2.74⫾2.0 vs. 6.7⫾5.9 respectively, P⬍0.05). Duration of ICU-stay was significantly lower in the L group. Conclusion. The use of L in high risk cardiac patients is superior to IABP in terms of maintaining stable haemodynamics during and after operation under CPB and reduction of ICU-stay. Low level of troponin-I 6 hours after the operation suggests cardioprotective properties of levosimendan. O-78 Anaesthetic techniques and transcatheter aortic valve implantation Marina Balanika, Anna Smyrli, Sofia Thomopoulou, Kostas Spargias, Vassilis Voudris, Stavroula Lacoumenta
S33
Onassis Cardiac Surgery Centre, Athens, Greece
Introduction. Transcatheter aortic valve implantation is an alternative therapeutic option for patients with severe aortic stenosis who are not considered as candidates for a conventional aortic valve replacement. The aim of this study was to evaluate the influence of the anaesthetic technique on the perioperative course and the postoperative outcome. Method. We reviewed the records of 98 patients who underwent a transcatheter aortic valve implantation. Patients were divided into two groups I and II. Group I received general anaesthesia (GA) while Group II monitored anaesthesia care (MAC). The following parameters were studied: anaesthesia and procedure duration, number of transfusions, cardiac index and superior vena caval saturation (ScVO2) before and after the aortic valve implantation, hospital length of stay and 30 day mortality. Statistical analysis was performed using Mann-Whitney U-test (P⬍0.05 was considered significant). Results. There were no statistically significant differences between the groups as far as the demographic data and all the other parameters studied are concerned with the exception of the duration anaesthesia and the ScVO2 value. Anaesthesia duration was significantly prolonged when general anaesthesia was administered (171.5⫾55.3 vs. 115.2⫾29.3 minutes, P⬍0.001). The ScVO2 was significantly higher both before (77.8⫾6.0 vs. 72.8⫾6.6, P⬍0.05) and after (79.2⫾6.1 vs. 75.3⫾5.9, P⬍0.05) the valve implantation in the same group of general anaesthesia. Conclusion. It seems that both anaesthesia techniques appear to be equally feasible and safe for these patients with a high logistic EuroSCORE. Increased ScVO2 value in Group I was due to higher PaO2 levels during general anaesthesia. [1] REFERENCE 1. Guinot PG, Depoix JP, Etchegoyen L, et al. Anesthesia and perioperative management of patients undergoing transcatheter aortic valve implantation: analysis of 90 consecutive patients with focus on perioperative complications. J Cardiothorac Vasc Anesth 2010; 24: 752-61. O-79 Preoperative statin treatment and postoperative atrial fibrillation (AF) in patients undergoing coronary surgery: a retrospective cohort study Paola Moliterni, Gabriele Nora Piazzoni, Erminio Sisillo
Papagni,
Cristina
Beverini,
Centro Cardiologico Monzino IRCCS, Milana, Italy Introduction. The purpose of the present study was to assess the preventive effect of preoperative statin treatment on the incidence of atrial fibrillation (POAF) during the first 48 postoperative hours in patients undergoing isolated, first time, coronary artery bypass grafting (CABG). Method. Data from patients in normal sinus rhythm (NSR) submitted to CABG between 2008 and 2010 were collected from our clinical database and reviewed for differences in incidence of AF (episodes of FA lasting ⬎10 minutes and registered by the monitoring system). Patients were divided into two groups: pa-