I wanted to bring you news of a fascinating study in the cardiology world. The US study sought to address the common atrial fibrillation (AF) as a common side effect post cardiac surgery. Unfortunately, AF is particularly prevalent after coronary artery bypass surgery (CABG) and is often difficult to reverse once initiated, it occurs in between 20% and 50% of patients.
AF is the most common arrhythmia worldwide and is a condition where the top chambers (atria) of the heart contract out of term with normal heart rhythm. Whilst not life threatening directly it can cause significant health issues. AF is associated with higher rates of blood clotting due to the added turbulence to the blood flow, this is in turn increases the risk of stroke and heart attack.
This new study tested spinal cord stimulation as a means of reducing the risk of AF onset after surgery. The small study followed 26 patients and monitored their heart rhythm for 30 days after CABG. The individuals given spinal cord stimulation had a lead implanted into the spine whilst under anaesthetic that was linked to an external device with settings controlled by a cardiologist. The device was implanted three days prior to CABG surgery and restarted after surgery for seven days, totalling 200 minutes of stimulation.
The implant group was compared to a control group who received standard medical care post surgery. In the control group, 30% of patients experienced AF post-surgery, whereas in the implant group only 4% did, representing a significant difference.
The reasons for why the intervention was so successful are not yet completely clear, nor is the reason why AF is so common post surgery. However it is likely associated with the disturbance to the neural connections in the heart and nervous system during surgery where the heart is manipulated and operated on. Having the stimulation may help to ‘pace’ the nervous system to allow for continuation of normal service.
This study is only the first steps into this area of research, but shows promising signs. There will need to be much more work done on reducing the need to implant such a device under anaesthetic and how to roll out to a wider patient group but this could mark the beginning of a preventative measure taken in future cardiac surgeries.