Impact of vasopressin use for postoperative atrial fibrillation in off-pump coronary artery bypass grafting

Postoperative atrial fibrillation complicates 15-40% of cardiac surgery cases and is associated with various adverse health outcomes including high mortality. Although vasopressin administration decreases postoperative atrial fibrillation in on-pump coronary artery bypass grafting, its use in off-pump coronary artery bypass grafting has not been investigated. Therefore, we evaluated the effect of vasopressin use in off-pump coronary artery bypass grafting. For this retrospective, observational study at a single-center community hospital in Yokkaichi, Japan, 298 patients who had undergone elective or emergency off-pump coronary artery bypass grafting between April 2015 and March 2021 were enrolled. Participants were divided into two groups: vasopressin and non-vasopressin groups. The outcomes in both groups were analyzed after propensity score matching, which revealed 40 patients in each matched group. Patients with chronic atrial fibrillation and those who were converted from off-pump to on-pump surgery were excluded. The primary outcome was postoperative atrial fibrillation occurrence within 4 days post-surgery. Secondary outcomes were 30-day mortality, intensive care unit and hospital stays, and postoperative complications (acute kidney injury, stroke, acute myocardial infarction, and respiratory complications). Although 11 patients (27.5%) in the vasopressin group were affected by postoperative atrial fibrillation when compared to 18 (45%) patients in the non-vasopressin groups, the difference was not significant (P=0.163). Similarly, no significant differences were observed in the secondary outcomes between groups. In off-pump coronary artery bypass grafting, vasopressin use may contribute to reduced postoperative atrial fibrillation; however, a large prospective study needs to be conducted for confirmation.