Coronary sinus lactate at reperfusion: A predictor of atrial fibrillation after coronary artery bypass grafting.
- 1Division of Cardiac Surgery, Mass General Brigham, Harvard Medical School, Boston, Mass.
Abstract
Objective
Postoperative atrial fibrillation (POAF) is the most common complication after coronary artery bypass grafting (CABG). This study explored the association of coronary sinus (CS) lactate levels with POAF after CABG.Methods
This was a single-center prospective cohort study of patients without a history of atrial fibrillation undergoing isolated CABG (December 2024 to February 2026). CS lactate was sampled before initiation of cardiopulmonary bypass (pre-CPB), before cross-clamp removal (pre-XC), and after cross-clamp removal (post-XC). POAF was defined as electrocardiogram-documented atrial fibrillation treated with amiodarone during the index hospitalization. Restricted cubic splines were used to define a binary cutoff of post-XC CS lactate at >3 mmol/L. Multivariable logistic regression was performed to assess the association between CS lactate elevation and POAF.Results
Of the 94 patients included, POAF occurred in 24 patients (26%). Patients with POAF were older and more commonly male but had similar median CPB time and XC duration. Patients with a post-XC lactate >3 mmol/L (n = 13/94, 14%) had significantly greater rates of POAF compared with those without lactate elevation (62% vs 20%, P = .001). After risk adjustment, post-XC lactate >3 mmol/L was associated with a 11.7-fold increase in odds of POAF (P = .010). Increasing age was also linked to greater likelihood of POAF. There was no significant association of POAF with CPB time, XC duration, pre-CPB CS lactate, or pre-XC CS lactate.Conclusions
Elevated CS lactate after cardiac reperfusion was associated with increased likelihood of POAF. Our findings suggest that CS lactate may be used to guide POAF prophylaxis.
Related
- Association of the triglyceride-glucose index and triglyceride-glucose-body mass index with postoperative atrial fibrillation in patients undergoing off-pump coronary artery bypass grafting: a retrospective cohort study
- Standardized 4-step surgical approach to address atrial fibrillation during coronary artery bypass grafting in a patient with severely reduced left ventricular function: a case report
- Reduced apelin expression and atrial fibrosis in postoperative atrial fibrillation following coronary artery bypass grafting
- Association between rhythm control strategy and clinical outcomes in postoperative atrial fibrillation after coronary artery bypass grafting: a retrospective cohort study
- Pericardial fluid cardiac troponin I predicts postoperative atrial fibrillation after coronary artery bypass grafting.
BibTeX
@article{verma2026coronary,
title = {{Coronary sinus lactate at reperfusion: A predictor of atrial fibrillation after coronary artery bypass grafting.}},
author = {Arjun Verma and Borami Shin and Sameer Hirji and Michael Gilfeather and Tommaso Hinna Danesi and Ashraf A Sabe and Thoralf M Sundt and Sary F Aranki},
journal = {JTCVS open},
year = {2026},
month = jul,
doi = {10.1016/j.xjon.2026.101971},
url = {https://europepmc.org/article/MED/42948100},
note = {CC BY},
}
RIS
TY - JOUR
TI - Coronary sinus lactate at reperfusion: A predictor of atrial fibrillation after coronary artery bypass grafting.
AU - Arjun Verma
AU - Borami Shin
AU - Sameer Hirji
AU - Michael Gilfeather
AU - Tommaso Hinna Danesi
AU - Ashraf A Sabe
AU - Thoralf M Sundt
AU - Sary F Aranki
PY - 2026
DA - 2026/07/24
JO - JTCVS open
DO - 10.1016/j.xjon.2026.101971
UR - https://europepmc.org/article/MED/42948100
AB - Objective Postoperative atrial fibrillation (POAF) is the most common complication after coronary artery bypass grafting (CABG). This study explored the association of coronary sinus (CS) lactate levels with POAF after CABG.Methods This was a single-center prospective cohort study of patients without a history of atrial fibrillation undergoing isolated CABG (December 2024 to February 2026). CS lactate was sampled before initiation of cardiopulmonary bypass (pre-CPB), before cross-clamp removal (pre-XC), and after cross-clamp removal (post-XC). POAF was defined as electrocardiogram-documented atrial fibrillation treated with amiodarone during the index hospitalization. Restricted cubic splines were used to define a binary cutoff of post-XC CS lactate at >3 mmol/L. Multivariable logistic regression was performed to assess the association between CS lactate elevation and POAF.Results Of the 94 patients included, POAF occurred in 24 patients (26%). Patients with POAF were older and more commonly male but had similar median CPB time and XC duration. Patients with a post-XC lactate >3 mmol/L (n = 13/94, 14%) had significantly greater rates of POAF compared with those without lactate elevation (62% vs 20%, P = .001). After risk adjustment, post-XC lactate >3 mmol/L was associated with a 11.7-fold increase in odds of POAF (P = .010). Increasing age was also linked to greater likelihood of POAF. There was no significant association of POAF with CPB time, XC duration, pre-CPB CS lactate, or pre-XC CS lactate.Conclusions Elevated CS lactate after cardiac reperfusion was associated with increased likelihood of POAF. Our findings suggest that CS lactate may be used to guide POAF prophylaxis.
SN - 2666-2736
ER -