Impact of Multiarterial versus Single Arterial Coronary Bypass Graft Surgery on Postoperative Atrial Fibrillation

Abstract

The effect of multiarterial (MA) versus single arterial (SA) coronary bypass graft surgery on postoperative atrial fibrillation (POAF) was not investigated. From May 2017 to May 2024, the patients with CYP2C19*2 or *3 allele receiving coronary artery grafting and postoperational aspirin 100 mg/day and clopidogrel 75 mg/day were retrospectively reviewed and assigned to the MA or SA group. The primary end point was the incidence rate of POAF in the first week. The secondary end points were POAF burden, platelet aggregation, systemic immune-inflammation index, and heart rate variability. The study included 58 cases in the MA group and 174 cases in the SA group. The incidence of POAF was 17% in the MA group, contrasting with 42% in the SA group (hazard ratio 0.353, 95% confidence interval 0.218 to 0.569, p = 0.0012). A lower POAF burden was observed in the MA group than in SA group (2 [1 to 5] vs 10 hours [6 to 20], p = 0.02). Platelet aggregation (arachidonic acid: 46 ± 10% vs 56 ± 8%, p <0.01; adenosine diphosphate: 58 ± 17% vs 75 ± 13%, p <0.01) and inflammation response index (neutrophil to lymphocyte ratio: 26 ± 4 vs 28 ± 5, p = 0.006; systemic immune-inflammation index: 5,019 ± 771 vs 5,382 ± 1,204, p = 0.032) was notably lower in MA group than those in SA group at 1 day after coronary artery bypass grafting. Holter electrocardiogram showed a higher heart rate variability value in the SD of the normal-to-normal RR intervals and decreased low frequency/high frequency ratio in the MA group. In conclusion, MA was associated with a lower incidence rate of POAF and paralleled with a lower atrial fibrillation burden, platelet aggregation, and inflammation reaction and a higher parasympathetic nerve tone than the SA regimen.