Atrial Na,K-ATPase Increase and Potassium Dysregulation Accentuate the Risk of Postoperative Atrial Fibrillation

Tran, Cao Thach; Schmidt, Thomas A.; Christensen, Jørgen Grønnegaard; Kjeldsen, Keld

doi:10.1159/000209264

Cited by 10 publications

(9 citation statements)

References 57 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This data suggests that even brief episodes of ischemia-reperfusion during off-pump surgery may cause local injury currents in the atria, which may be significant because the atria are the most sensitive to high K + (Figure 5). In 2009, Tran and colleagues also reported a link between plasma K + during cardiac surgery and post-operative atrial fibrillation (Tran et al, 2009). Thus, hyperkalemia, whether imposed on the heart from depolarizing K + in surgical cardioplegia or from bouts of regional ischemia during beating heart surgery, may be linked functionally to membrane depolarization and an activated endothelium and inflammatory response, which collectively promote the generation of atrial (and ventricular) arrhythmias.…”

Section: Five Areas Of Concern With Hyperkalemic Cardioplegiamentioning

confidence: 99%

Hyperkalemic cardioplegia for adult and pediatric surgery: end of an era?

Dobson¹,

Faggian²,

Onorati³

et al. 2013

Front. Physiol.

View full text Add to dashboard Cite

Despite surgical proficiency and innovation driving low mortality rates in cardiac surgery, the disease severity, comorbidity rate, and operative procedural difficulty have increased. Today's cardiac surgery patient is older, has a “sicker” heart and often presents with multiple comorbidities; a scenario that was relatively rare 20 years ago. The global challenge has been to find new ways to make surgery safer for the patient and more predictable for the surgeon. A confounding factor that may influence clinical outcome is high K+ cardioplegia. For over 40 years, potassium depolarization has been linked to transmembrane ionic imbalances, arrhythmias and conduction disturbances, vasoconstriction, coronary spasm, contractile stunning, and low output syndrome. Other than inducing rapid electrochemical arrest, high K+ cardioplegia offers little or no inherent protection to adult or pediatric patients. This review provides a brief history of high K+ cardioplegia, five areas of increasing concern with prolonged membrane K+ depolarization, and the basic science and clinical data underpinning a new normokalemic, “polarizing” cardioplegia comprising adenosine and lidocaine (AL) with magnesium (Mg2+) (ALM™). We argue that improved cardioprotection, better outcomes, faster recoveries and lower healthcare costs are achievable and, despite the early predictions from the stent industry and cardiology, the “cath lab” may not be the place where the new wave of high-risk morbid patients are best served.

show abstract

Section: Five Areas Of Concern With Hyperkalemic Cardioplegiamentioning

confidence: 99%

Hyperkalemic cardioplegia for adult and pediatric surgery: end of an era?

Dobson¹,

Faggian²,

Onorati³

et al. 2013

Front. Physiol.

View full text Add to dashboard Cite

show abstract

“…Within the normal range for serum K concentrations, this risk was increased three fold for patients with low serum K concentration compared to patients with high serum K concentration [3,4]. In addition, impaired K homeostasis has been found to be of importance for the development of atrial fibrillation [5]. Finally, it should be noted that hypokalemia has been reported to be insufficiently handled in 24% of hospitalized patients [6].…”

Section: Introductionmentioning

confidence: 99%

“…It may be advisable to avoid hypokalemia when using b adrenoceptor agonists and to maintain pK in the upper normal range if at the risk of arrhythmia. development of atrial fibrillation [5]. Finally, it should be noted that hypokalemia has been reported to be insufficiently handled in 24% of hospitalized patients [6].…”

Section: Introductionmentioning

confidence: 99%

Protection against β adrenoceptor agonist reduction of plasma potassium in severe but not in moderate hypokalemia

Tran

Kjeldsen

2011

Fundamental &Amp; Clinical Pharmacology

Self Cite

View full text Add to dashboard Cite

K-depleted and control rats were anesthetized and infused with terbutalin. In controls, plasma K concentration (pK) decreased by 0.7 mm (P = 0.01). In moderate hypokalemia terbutalin-induced decrease in pK was reduced by 0.3 mm for each 1 mm decrease in pK (n = 8, R(2) = 0.82, P = 0.002) and by 0.2 mm for each 10 mmol/g wet wt. decrease in muscle K content (n = 8, R(2) = 0.66, P = 0.01). Hence, for baseline pK of 4, 3 and 2 mm, decrease in pK was 0.7, 0.4 and 0.1 mm, respectively. In severe hypokalemia (1.7 mm), terbutain induced no further reduction in pK. The combined infusion of insulin and terbutalin showed no additive effect. Normalization of pK by KCl infusion in severe hypokalemia immediately abolished protection against terbutalin induced further pK reduction. Hence, terbutalin clamped pK at around 4 mm, whereas it continued to increase to around 5 mm without terbutalin infusion. Major new findings are: Protection against terbutalin induced further reduction in pK in severe pre-existing hypokalemia (<2 mm) and blunted but nevertheless severe further reduction in pK in more moderate pre-existing hypokalemia; immediate abolishment of protection by normalization of pK; protection against additive reduction in pK by terbutalin and insulin in severe hypokalemia. It may be advisable to avoid hypokalemia when using β adrenoceptor agonists and to maintain pK in the upper normal range if at the risk of arrhythmia.

show abstract

“…It has also been demonstrated that elevated epinephrine arising from preoperative anxiety stimulated the b-2 adrenoceptor and the Na/K-ATPase that transports potassium into liver or skeletal muscle cell bodies and reduces extracellular and plasma potassium concentrations [11][12][13][16][17][18][19]. Previous studies reported that preinduction serum potassium concentrations were significantly lower than those measured in the outpatient department, a finding which was attributed to increased catecholamine due to preoperative anxiety, as determined by measurements of serum epinephrine levels [11,12].…”

Section: Discussionmentioning

confidence: 99%