Atrial fibrillation after coronary artery bypass grafting is associated with sympathetic activation

Jonathan M. Kalman, Muhammad Munawar, Laurence G. Howes, William J. Louis, Brain F. Buxton, Geoffrey Gutteridge, Andrew M. Tonkin

Research output: Contribution to journalArticlepeer-review

303 Citations (Scopus)


BackgroundWe prospectively investigated the role of sympathetic activation in the etiology of atrial fibrillation following coronary artery bypass grafting. Methods.: Continuous ambulatory monitoring was performed for 80 hours in 131 patients after coronary artery bypass grafting. Right atrial plasma norepinephrine levels were assessed preoperatively and every 4 hours for 48 hours postoperatively. Results.: Of the 131 patients, 50% (65) had development of atrial fibrillation and 36% (47) required treatment. Onset of atrial fibrillation was preceded by a significant increase in sinus rate and atrial ectopic activity. On multivariate logistic regression, elevated mean postoperative norepinephrine levels (5.78 ± 2.83 versus 3.57 ± 1.31 nmol/L; p < 0.0001), increased age (68.9 ± 5.7 versus 63.8 ± 8.7 years; p = 0.02), and decreased postoperative magnesium levels (0.79 ± 0.09 versus 0.83 ± 0.10 mmol/L; p = 0.02) were independently associated with the occurrence of atrial fibrillation. Conclusions.: Elevated norepinephrine levels suggest that sympathetic activation may be important in the pathogenesis of atrial fibrillation after coronary artery bypass grafting, and this underlines the importance of β-adrenoceptor blockade as prophylaxis.

Original languageEnglish
Pages (from-to)1709-1715
Number of pages7
JournalThe Annals of Thoracic Surgery
Issue number6
Publication statusPublished - Dec 1995


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