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Fascicular Conduction Disturbances After Coronary Artery Bypass Surgery: A Review With a Meta‐Analysis of Their Long‐term Significance
Author(s) -
Kumbhani Dharam J.,
Sharma G.V.R.K.,
Khuri Shukri F.,
Kirdar Jamil A.
Publication year - 2006
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/j.1540-8191.2006.00264.x
Subject(s) - medicine , meta analysis , coronary artery bypass surgery , cardiology , term (time) , artery , conduction abnormalities , physics , quantum mechanics
Fascicular conduction abnormalities are frequently reported following adult cardiac surgery, but their pathogenesis and long‐term outcomes remain unclear. In this article, we review the epidemiological features, pathogenesis, diagnosis, and management, and the short‐term and long‐term significance of fascicular conduction abnormalities following coronary artery bypass graft (CABG) surgery, based on data from 30 studies. Conduction disturbances have an incidence of 3.4% to 55.8% after CABG surgery, the most common being right bundle branch block (RBBB). RBBB is usually transient and benign. Although a slew of factors have been implicated in the pathogenesis of fascicular conduction disturbances, the two most important factors are myocardial ischemia and type of cardioplegia. While a 12‐lead electrocardiogram is the gold standard for diagnosis, additional tests such as myocardial enzymes or echocardiography may have additional diagnostic and prognostic value. Short‐term prognosis after RBBB is good, but its impact on long‐term survival is unclear. We conducted a meta‐analysis, the first of its kind in this area, using long‐term survival data from five studies. There was no difference in long‐term survival between patients who developed conduction disturbances after CABG surgery, and those who did not, indicating a benign influence of conduction disturbances on long‐term survival, and the lack of the necessity for monitoring or pacing. While the older literature reported an adverse impact of fascicular conduction disturbances on long‐term survival, the more recent studies report a substantially reduced mortality after CABG surgery, despite a higher incidence of conduction disturbances, pointing to the effect of improved surgical techniques.