Is atrial function affected by conventional cardioplegic arrest?

Conventional cardioplegic arrest results in persistent atrial electrical and mechanical activity. This activity has been postulated to result in atrial ischemia which can induce postoperative arrhythmias and impair the transport function of the atrium. In this study, the effects of simple cardiopulmonary bypass (CPB) (seven pigs) and conventional cardioplegic arrest (CCA) (seven pigs) on right atrial function were evaluated. Function was assessed in an isolated right atrial preparation with a compliant balloon inserted via the superior vena cava. CCA for 1 hr produced significant deterioration in right atrial function (developed pressure 14.1 ± 0.7 vs 18.9 ± 0.8 mm Hg, P < 0.05, diastolic pressure 10.0 ± 1 vs 4.5 ± 1.4 mm Hg, P < 0.05, dP dt 134 ± 25 vs 187 ± 19 mm Hg/sec, P < 0.05 at a balloon volume of 20 ml after 1 hr of reperfusion). CPB alone caused no alteration in pressures in the right atrium but was associated with a late decrease in dP dt (developed pressure 19.3 ± 1.8 vs 18.9 ± 0.8 mm Hg, diastolic pressure 4.0 ± 1.2 vs 4.5 ± 1.4 mm Hg, dP dt 148 ± 18 vs 187 ± 19, P < 0.05 at a balloon volume of 20 ml at a time corresponding to 1 hr of reperfusion in the CCA group). These results are consistent with the postulate that conventional techniques of cardioplegic arrest are associated with ischemic dysfunction of the right atrium.