Stellate Ganglion to Prevent Atrial Fibrillation

New onset atrial fibrillation is a common problem after cardiac surgery. The reported incidence after coronary artery bypass grafting (CABG) is 15-40%, 37-50% after valve surgery, and up to 60% after CABG and valve surgery. Post-operative atrial fibrillation (POAF) is associated with increase risk for stroke, increased length of hospital stay, increase risk of other new arrhythmias, increased need for pacemaker implantation, and increased mortality. Several interventions have been implemented in order to prevent post-operative atrial fibrillation including use of betablockers, sotalol, amiodarone, atrial pacing, and antioxidant vitamins. Despite these interventions (several carry risk of adverse effects) POAF remains common.Cardiac sympathetic innervation arises from the stellate ganglion. Stellate ganglion block (SGB) with local anesthetic agents (lidocaine or bupivacaine) can reduce sympathetic output to the heart with minimal side effects. This procedure has been successfully utilized in patients with medication refractory ventricular arrhythmias. In atrial tissue SGB has been shown to prolong atrial effective refractory periods, reduce atrial arrhythmia inducibility, and shorten atrial fibrillation duration in patients who have atrial fibrillation. Pre-operative SGB has been utilized to prevent post-operative radial artery spasm (when the radial artery was used a coronary bypass graft conduit). The investigators hypothesize that pre-operative SGB will reduce the incidence of post-operative new atrial fibrillation in patients undergoing cardiac surgery.

Inclusion Criteria:Patients > 18 years old scheduled to undergo elective coronary artery bypass (CABG) surgery based on current surgical guidelines.Exclusion Criteria:Prior history of atrial fibrillationCurrent antiarrhythmic use (other than beta blockers)Inability of patient to provide consent for themselves either due to medical or psychiatric comorbidityNon-elective surgeryPatients undergoing mitral valve replacement or repair surgeryPatients undergoing surgical MAZE procedurePregnancyHistory of neck surgerySystemic or local infectionCurrent coagulopathyPathologic bradycardia (baseline heart rate <50 beats/minute or untreated atrioventricular block)History of glaucomaAllergy to lidocaine