Atrial Fibrillation After Coronary Artery Bypass Surgery

Zaman, Azfar; Archbold, R. Andrew; Helft, Gérard; Paul, Elizabeth; Curzen, Nicholas; Mills, Peter

doi:10.1161/01.cir.101.12.1403

Cited by 283 publications

(282 citation statements)

References 45 publications

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“…For instance, Hogue and Hyder (1) observed that in addition to age, valvular heart operation is the most consistently identified risk factor for cardiac arrhythmia. Similar to the present results (age, ≥60 years; P<0.001), Zaman et al (6) found that advanced age is markedly associated with postoperative AF (65.9 vs. 61.7 years; P<0.0005). The frequency of this arrhythmia is increasing, possibly due to the rising proportions of elderly patients undergoing cardiac surgery.…”

Section: Discussionsupporting

confidence: 90%

“…Postoperative AF (POAF) is frequently considered to be a temporary problem; however, this complication results in significant adverse effects. POAF increases the risk of a cerebrovascular accident, extending the duration of hospital stay and the requirement for intensive care (4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

“…Although nearly all patients present at least one of the aforementioned risk factors, ~60% of patients undergoing cardiac surgery do not develop AF; thus, only certain patients seem to possess an inherent or acquired preoperative risk (6,10). Therefore, these factors suggest that the major determinants of the risk for the development of POAF include the patient's preoperative status and condition of the atria, as well as the ischemia and stress induced by the surgical procedure.…”

Section: Introductionmentioning

confidence: 99%

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Clinical and histological predictive risk factors of atrial fibrillation in patients undergoing open-heart surgery

Tinică¹,

Mocanu²,

Zugun‐Eloae³

et al. 2015

Experimental and Therapeutic Medicine

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Abstract. Postoperative atrial fibrillation (POAF) is a common complication subsequent to cardiac surgery. Various risk factors have been reported for the development of this complication; however, their precise role in POAF is unknown. In the present study, we attempted to identify clinical factors and histopathological changes in atrial tissue that may predict the development of POAF. Atrial tissue was sampled from 103 patients in sinus rhythm that had undergone open-heart surgery, including elective coronary artery bypass grafting (79.61%) and heart valve surgery (20.38%). Atrial surgical biopsies were obtained from the right atrial appendage at the site of cannulation, prior to cardiopulmonary bypass. Tissues were processed routinely for light microscopy, then stained with hematoxylin and eosin and sirius red. Microscopical exams were used to observe the atrial lesions and morphometry was conducted for quantification. In total, 37 patients (35.92%) developed POAF and atrial lesions were identified in the majority of patients in the normal postoperative sinus rhythm and POAF groups, but were most common in the POAF patients. The most common risk factors involved in developing POAF were found to be: Age of >60 years, male gender, ejection fraction of <50% and increased pulmonary hypertension. Furthermore, interstitial fibrosis and myocytolysis were the most common injuries identified. Abnormalities in atrial surgical biopsies may indicate the susceptibility of a patient to developing POAF. The present results suggest that the pre-existent alterations in the structure of the right atrium may be a major determinant in the development of POAF.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical and histological predictive risk factors of atrial fibrillation in patients undergoing open-heart surgery

Tinică¹,

Mocanu²,

Zugun‐Eloae³

et al. 2015

Experimental and Therapeutic Medicine

View full text Add to dashboard Cite

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“…Among the main risk factors contributing to the onset of this arrhythmia are: old age, male gender, valve disease, increased atrial size, previous arrhythmias, chronic obstructive pulmonary disease, previous cardiac surgery, discontinuation of betablockers, use of digoxin, ventricular dysfunction and anemia 11 .…”

Section: Introductionmentioning

confidence: 99%

Prevenção de fibrilação atrial com amiodarona em moderada dosagem no pós-operatório de cirurgia cardíaca é segura e eficaz em pacientes de alto risco para desenvolver essa arritmia

Alves

Geovanini

Brito

et al. 2007

Arq. Bras. Cardiol.

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SummaryObjective: To assess if prophylaxis with moderate doses of amiodarone in the postoperative period of cardiac surgery (coronary artery bypass grafting and/or valve surgery), reduces the incidence of atrial fibrillation in patients with high risk for developing this arrhythmia.Methods: A randomized and prospective clinical study involving 68 patients who underwent elective cardiac surgery. Mean age was 64 years and 59% of participants were males. Patients with three or more risk factors for atrial fibrillation, according to the literature, were randomized into two groups to receive or not prophylaxis with amiodarone in the first postoperative day. The dose administered ranged from 600 mg/day to 900 mg/day, intravenously, on the first postoperative day, followed by 400 mg/day orally until hospital discharge or until completing seven days. The other patients, who presented two or fewer risk factors, were followed up until hospital discharge. All patients were evaluated by means of cardiac and/or electrocardiographic monitoring.

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“…1 Although often transient and benign, AF after CABG prolongs hospital stay and may lead to complications such as hemodynamic instability or thromboembolic events. 2 The mechanism of AF after CABG is not well defined; however, animal studies as well as clinical case studies suggest that endogenous adenosine, released in response to tissue hypoxia, may play a mechanistic role in these arrhythmias. 3,4 It is postulated that endogenous adenosine, released during the surgical procedure, shortens the atrial action potential duration and effective refractory period.…”

Section: Introductionmentioning

confidence: 99%

Role of endogenous adenosine in atrial fibrillation after coronary artery bypass graft

Yavuz

Bertolet

Bebooul

et al. 2004

Clinical Cardiology

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Background: Atrial fibrillation (AF) is the most common complication following coronary artery bypass graft (CABG). The mechanism of AF after CABG is not well defined; however, it is suggested that endogenous adenosine, released in response to tissue hypoxia, may play a mechanistic role in these arrhythmias. Hypothesis: The purpose of this study was to examine whether intravenous theophylline, via adenosine A1 receptor antagonism, would correct or modify new‐onset early (< 48 h post CABG) atrial fibrillation in patients post CABG, and thereby implicate endogenous adenosine as an inciting agent. Methods: A prospective double‐blind, placebo‐controlled study design was applied to 385 consecutive patients with coronary artery disease who had undergone CABG. Any patient who developed AF within 48 h of the operative procedure was randomly assigned to receive 5 mg/kg of intravenous theophylline (Group A) or matched intravenous placebo (Group B). The patients who converted to sinus rhythm within 15 min of drug administration were accepted as showing positive responses. Results: Thirty patients comprised the study group. In Group A, 8 of the 15 patients (53%) converted from AF to sinus rhythm within 15 min of theophylline administration. One patient who converted to sinus rhythm 20 min after theophylline administration was accepted as showing a negative response. In the placebo‐treated group, no patient converted to sinus rhythm within 15 min (p < 0.007 compared with Group A). Conclusions: The mechanism of AF after CABG is not well defined and is probably multifactorial. However, this study demonstrated that antagonism of the adenosine A1 receptor can promptly convert many of these patients back to sinus rhythm, and thereby implicates endogenously released adenosine in a mechanistic role for inciting early (< 48 h) post‐CABG AF.

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Atrial Fibrillation After Coronary Artery Bypass Surgery

Abstract: A combination of prolonged SAPD, advanced age, and male sex identifies patients at high risk for development of AF after CABG.

Cited by 283 publications

References 45 publications

Clinical and histological predictive risk factors of atrial fibrillation in patients undergoing open-heart surgery

Clinical and histological predictive risk factors of atrial fibrillation in patients undergoing open-heart surgery

Prevenção de fibrilação atrial com amiodarona em moderada dosagem no pós-operatório de cirurgia cardíaca é segura e eficaz em pacientes de alto risco para desenvolver essa arritmia

Role of endogenous adenosine in atrial fibrillation after coronary artery bypass graft

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