Atrial Fibrillation After Cardiac Surgery: Clinical Update on Mechanisms and Prophylactic Strategies

Raiten, Jesse; Ghadimi, Kamrouz; Augoustides, John; Ramakrishna, Harish; Patel, Prakash A.; Weiss, Stuart J.; Gutsche, Jacob T.

doi:10.1053/j.jvca.2015.01.001

Cited by 62 publications

(43 citation statements)

References 134 publications

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“…28–31 A large randomized clinical trial about steroid therapy for POAF is now ongoing. 32 The present study showed that anti-inflammatory therapy reduced the atrial inflammation after the atriotomy, resulting in a homogeneous atrial conduction and lower incidence of induced POAF, although the dosages of methylprednisolone used in the present study were adequately high enough to completely suppress the inflammatory response, and such high doses would not be acceptable for humans because of the resulting complications, such as a high risk of infection.…”

Section: Discussionmentioning

confidence: 99%

Postoperative atrial fibrillation: The role of the inflammatory response

Ishii

Schuessler

Gaynor

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

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Objective Abnormal atrial conduction has been shown to be a substrate for postoperative atrial fibrillation (POAF). This study aimed to determine the relationship between the location of the atrial reentry responsible for POAF, and degree of atrial inflammation. Methods Normal mongrel dogs (n = 18) were divided into 3 groups: anesthesia alone (anesthesia), lateral right atriotomy (atriotomy), and lateral right atriotomy with anti-inflammatory therapy (steroid). Conduction properties of the right and left atria (RA and LA) were examined 3 days postoperatively by mapping. Activation was observed during burst pacing–induced AF. The RA and LA myeloper-oxidase activity was measured to quantitate the degree of inflammation. Results Sustained AF (>2 minutes) was induced in 5 of 6 animals in the atriotomy group, but in none in the anesthesia or steroid groups. All sustained AF originated from around the RA incision. Three of these animals had an incisional reentrant tachycardia around the right atriotomy and 2 had a focal activation arising from the RA during AF. The LA activations in these animals were passive from the RA activation. The RA activation of the atriotomy group was more inhomogeneous than that of the anesthesia group (inhomogeneity index: 2.0 ± 0.2 vs 1.0 ± 0.1, P<.01). Steroid therapy significantly normalized the RA activation after the atriotomy (1.2 ± 0.1, P<.01). The inhomogeneity of the atrial conduction correlated with the myeloperoxidase activity (r = 0.774, P<.001). Conclusions Reentrant circuits responsible for POAF are dependent on the degree of inflammation and rotate around the atriotomy. Anti-inflammatory therapy decreased the risk of postoperative AF.

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Section: Discussionmentioning

confidence: 99%

Postoperative atrial fibrillation: The role of the inflammatory response

Ishii

Schuessler

Gaynor

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

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“…Advanced age strongly associated with POAF is the only consistent finding in all the studies (2,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21).…”

Section: Discussionmentioning

confidence: 56%

“…The predictive value of different analyzed models was in-fluenced by the variables involved and the number of patients included. Studies reporting risk factors for POAF have described different variables, but there are only a few prediction models, mainly for patients undergoing coronary artery bypass grafting (CABG) or combined surgical procedures (9,10,(14)(15)(16). Our aim was to test a population of patients undergoing SAVR, excluding other surgical procedures such as CABG or mitral valve surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Most proposed preventive resources include the administration of antiarrhythmic or anti-inflammatory medications (5) or intraoperative procedures, such as atrial pacing (6,7). Despite the efficacy of the prophylactic regimens for POAF, routine prevention protocols are not used in many cardiac surgery units, probably due to the drug regimens and their side effects (7)(8)(9). In addition, the etiology of POAF is not clearly understood, which can impacts the surgeon's willingness to practice various types of proposed prophylactic treatments.…”

Section: Introductionmentioning

confidence: 99%

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Postoperative atrial fibrillation prediction following isolated surgical aortic valve replacement

Iliescu¹

2018

Anatol J Cardiol

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ObjectivePostoperative atrial fibrillation (POAF) is the most common complication following cardiac surgery, with increased risk of stroke and high mortality. Our aim was to identify patients at risk and to design a model that could predict POAF.MethodsIn this single center study, we evaluated 1191 patients requiring isolated surgical aortic valve replacement between January 2000 and June 2014. The patients were followed during the early postoperative period until discharge.ResultsAF occurred in 342 patients (28.71%). Six variables associated with high arrhythmic risk [advanced age, body mass index, tricuspid regurgitation, prolonged ventilation, longer intensive care unit stay, and dilated left atrium (LA; volume ≥35 ml/m2)] were selected to create a multivariate prediction model. This model predicted POAF in 64.7% of cases, with a moderate discriminative power (AUC=0.65; p=0.001; 95% CI, 0.571-0.771). We also developed the CHAID (Chi-square automatic interaction detection) model showing multilevel interactions among risk factors for POAF. Age had the greatest discriminative power, with patients aged >68 years at a higher risk for POAF. In low-risk patients, the subgroup with dilated LA (volume ≥40 ml) was more prone to develop POAF. For the intermediate-risk group, history of AF was the next deciding variable, whereas for the high-risk group, it was tricuspid regurgitation (at least moderate).ConclusionThe multivariate logistic model has an acceptable predictive value. CHAID-derived model is a new tool that could be easily applied to identify patients requiring prophylactic regimens.

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“…[15][16][17] It is, therefore, important to develop new risk prediction models for identifying patients who are most likely to benefit from prophylactic therapies, such as beta blockers, statins, amiodarone, colchicine, and biatrial pacing during the preoperative period. [18] The SS is an anatomically-based tool to determine the complexity of CAD and to guide decision-making between CABG and PCI in patients with unprotected left main CAD or three-vessel disease. Each coronary lesion with a diameter of stenosis ≥50% in vessels ≥1.5 mm is scored in SS.…”

Section: Discussionmentioning

confidence: 99%