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The Journal of Thoracic and Cardiovascular Surgery, Vol 104, 297-306, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
S Sato, S Yamauchi, RB Schuessler, JP Boineau, Y Matsunaga and JL Cox
The purpose of this study was to test the assumption that the cause for
postoperative atrial flutter/fibrillation after cardiopulmonary bypass is
inadequate atrial myocardial protection. Dogs were subjected to
cardioplegic arrest for 60 minutes without augmented atrial hypothermia
(seven dogs, control group) or augmented atrial hypothermia with topical
atrial cooling (seven dogs, study group). Twenty-five electrodes (15 on the
right atrium and 10 on the left atrium) were fixed on the atria to measure
effective refractory period and conduction time. Data were taken before
bypass, immediately after bypass, and 2 hours after bypass. During
cardioplegic arrest the mean temperatures measured in the atria were
significantly lower (p less than 0.001) in the study group (13.5 degrees
+/- 7.0 degrees C) than in the control group (23.7 degrees +/- 3.2 degrees
C). There was no significant change in the mean effective refractory period
after bypass in the control or study groups or in the prevalence of
inducibility of atrial flutter/fibrillation by extrastimulation (3/7 dogs
in the control group and 2/7 in the study group). During right atrial
pacing, total conduction times were significantly longer (p less than 0.025
at cycle lengths of 300 and 350 msec) in the control group (74 +/- 5 msec
and 75 +/- 7 msec, respectively) than in the study group (65 +/- 9 msec and
64 +/- 8 msec, respectively) immediately after bypass. Two hours after
bypass, however, there were no significant differences under the same
conditions between the two groups. There were no significant differences in
conduction during left atrial pacing after bypass. Comparing those atria
that were inducible with those not inducible demonstrated a significantly
increased dispersion of effective refractory period (90 +/- 23 msec versus
74 +/- 18 msec, p less than 0.05) and increased conduction time in the
inducible group. We concluded that augmented atrial hypothermia during
cardioplegic arrest had no effect on the inducibility of fibrillation, had
no effect on repolarization, and had only a small effect on conduction,
which resolved within 2 hours after bypass. However, the study demonstrates
that when the atria are inducible the substrates are an increased
dispersion of refractoriness and a prolongation of conduction time.
ARTICLES
The effect of augmented atrial hypothermia on atrial refractory period, conduction, and atrial flutter/fibrillation in the canine heart
Department of Surgery, Washington University School of Medicine, Barnes Hospital, St. Louis, Mo.
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