2007 Heart-Brain summit proceedings
Clinical hypnosis for reduction
of atrial fibrillation after coronary artery bypass graft surgery
ABSTRACT
The belief that postoperative atrial fibrillation (PAF) results from transient autonomic dysfunction suggests that interventions such as clinical hypnosis may reduce the incidence of PAF. To explore this hypothesis, we retrospectively compared outcomes between two groups of patients undergoing coronary artery bypass graft surgery: 50 consecutive patients who received preoperative hypnoidal explanation of the surgical procedure and 50 case-matched historical controls who received no clinical hypnosis. The patients who received hypnosis were significantly less likely to experience an episode of PAF (P = .003) and showed nonsignificant trends toward superior outcomes in terms of length of stay, narcotic use, and total hospital charges. Our findings indicate that prospective randomized trials are warranted to further delineate the potential benefit of clinical hypnosis for prevention of PAF.
CITATIONS
- Halonen J, Hakala T, Auvinen T, et al.
Intravenous administration of metoprolol is more effective than oral administration in the prevention of atrial fibrillation after cardiac surgery. Circulation 2006; 114(1 Suppl):I1–I4.
http://www.ncbi.nlm.nih.gov/pubmed/16820555 - Mathew JP, Parks R, Savino JS, et al.
Atrial fibrillation following coronary artery bypass graft surgery: predictors, outcomes, and resource utilization. MultiCenter Study of Perioperative Ischemia Research Group. JAMA 1996; 276:300–306.
http://www.ncbi.nlm.nih.gov/pubmed/8656542 - Bettoni M, Zimmermann M.
Autonomic tone variations before the onset of paroxysmal atrial fibrillation. Circulation 2002; 105:2753–2759.
http://www.ncbi.nlm.nih.gov/pubmed/12057990 - Chen J, Wasmund SL, Hamdan MH.
Back to the future: the role of the autonomic nervous system in atrial fibrillation. Pacing Clin Electrophysiol 2006; 29:413–421.
http://www.ncbi.nlm.nih.gov/pubmed/16650271 - Hogue CW Jr, Creswell LL, Gutterman DD, Fleisher LA; American
College of Chest Physicians.
Epidemiology, mechanisms, and risks: American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillation after cardiac surgery. Chest 2005; 128(2 Suppl):9S–16S.
http://www.ncbi.nlm.nih.gov/pubmed/16167659 - Lombardi F, Tarricone D, Tundo F, Colombo F, Belletti S,
Fiorentini C.
Autonomic nervous system and paroxysmal atrial fibrillation: a study based on the analysis of RR interval changes before, during and after paroxysmal atrial fibrillation. Eur Heart J 2004; 25:1242–1248.
http://www.ncbi.nlm.nih.gov/pubmed/15246643 - Tomita T, Takei M, Saikawa Y, et al.
Role of autonomic tone in the initiation and termination of paroxysmal atrial fibrillation in patients without structural heart disease. J Cardiovasc Electrophysiol 2003; 14:559–564.
http://www.ncbi.nlm.nih.gov/pubmed/12875412 - Aasbo JD, Lawrence AT, Krishnan K, Kim MH, Trohman RG.
Amiodarone prophylaxis reduces major cardiovascular morbidity and length of stay after cardiac surgery: a meta-analysis. Ann Intern Med 2005; 143:327–336.
http://www.ncbi.nlm.nih.gov/pubmed/16144891 - Hippel CV, Hole G, Kaschka WP.
Autonomic profile under hypnosis as assessed by heart rate variability and spectral analysis. Pharmacopsychiatry 2001; 34:111–113.
http://www.ncbi.nlm.nih.gov/pubmed/11434402 - de Klerk JE, du Plessis WF, Steyn HS, Botha M.
Hypnotherapeutic ego strengthening with male South African coronary artery bypass patients. Am J Clin Hypn 2004; 47:79–92.
http://www.ncbi.nlm.nih.gov/pubmed/15554461 - Saadat H, Drummond-Lewis J, Maranets I, et al.
Hypnosis reduces preoperative anxiety in adult patients. Anesth Analg 2006; 102:1394–1396.
http://www.ncbi.nlm.nih.gov/pubmed/16632816 - Villareal RP, Hariharan R, Liu BC, et al.
Postoperative atrial fibrillation and mortality after coronary artery bypass surgery. J Am Coll Cardiol 2004; 43:742–748.
http://www.ncbi.nlm.nih.gov/pubmed/14998610 - Maisel WH, Rawn JD, Stevenson WG.
Atrial fibrillation after cardiac surgery. Ann Intern Med 2001; 135:1061–1073.
http://www.ncbi.nlm.nih.gov/pubmed/11747385 - Nickerson NJ, Murphy SF, Dávila-Román VG, Schechtman KB,
Kouchoukos NT.
Obstacles to early discharge after cardiac surgery. Am J Manag Care 1999; 5:29–34.
http://www.ncbi.nlm.nih.gov/pubmed/10345964 - Hravnak M, Hoffman LA, Saul MI, et al.
Resource utilization related to atrial fibrillation after coronary artery bypass grafting. Am J Crit Care 2002; 11:228–238.
http://www.ncbi.nlm.nih.gov/pubmed/12022486 - Hogue CW Jr, Domitrovich PP, Stein PK, et al.
RR interval dynamics before atrial fibrillation in patients after coronary artery bypass graft surgery. Circulation 1998; 98:429–434.
http://www.ncbi.nlm.nih.gov/pubmed/9714093 - Olshansky B.
Interrelationships between the autonomic nervous system and atrial fibrillation. Prog Cardiovasc Dis 2005; 48:57–78.
http://www.ncbi.nlm.nih.gov/pubmed/16194692 - Zhang J.
Effect of age and sex on heart rate variability in healthy subjects. J Manipulative Physiol Ther 2007; 30:374–379.
http://www.ncbi.nlm.nih.gov/pubmed/17574955 - Taggart P, Sutton P, Redfern C, et al.
The effect of mental stress on the non-dipolar components of the T wave: modulation by hypnosis. Psychosom Med 2005; 67:376–383.
http://www.ncbi.nlm.nih.gov/pubmed/15911899