Calcium-Induced Autonomic Denervation in Patients With Post-Operative Atrial Fibrillation

Wang, Huishan; Zhang, Yuji; Xin, Fangran; Jiang, Hui; Tao, Dengshun; Jin, Yan; He, Yuanchen; Wang, Qiang; Po, Sunny S.

doi:10.1016/j.jacc.2020.10.049

Cited by 42 publications

(47 citation statements)

References 26 publications

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“…Amiodarone belongs to the class of antiarrhythmics and is a peripheral and coronary vasodilator [ 41 ]. It is granted Class IIA indication by both American and European guidelines and is one of the most effective treatments for POAF [ 42 ]. However, amiodarone presents with serious cardiac and extracardiac adverse risks, such as bradycardia, increased liver enzymes, hyperthyroidism, thyrotoxicosis, and interstitial pneumonitis.…”

Section: Methodsmentioning

confidence: 99%

“…Accumulation of the drug may also lead to longer lasting side effects after discontinuing the drug [ 7 ]. Local epicardial application of amiodarone hydrogel has been shown to reduce the adverse outcomes of amiodarone and have a decrease in POAF incidence from 22-37% to 3.3-8% [ 7 , 42 ]. While these studies were small in sample size (~ 60), they show promise for an effective therapeutic for POAF.…”

Section: Methodsmentioning

confidence: 99%

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Post-Operative Atrial Fibrillation: Current Treatments and Etiologies for a Persistent Surgical Complication

Lopes¹,

Agrawal²

2022

J Surg Res

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Post-operative atrial fibrillation (POAF) is a persistent and serious surgical complication that occur in 20-55% of cardiac surgery cases. POAF may lead to adverse health outcomes such as stroke, thromboembolism, cardiac arrest, and mortality, and may develop long-term. Patients have a 2-fold increase in mortality risk and spend about 3.7 more days in the hospital and $16,000 more in medical costs during their visit. The mechanisms and risk factors of POAF are still poorly understood, yet a strong foundation of how a disease process occurs is needed to provide the most effective treatment. Current mechanisms that are postulated to contribute to POAF include an increase in sympathetic tone, oxidative stress, local and systemic inflammation, a trigger that induces atrial substrate changes, a driver to sustain POAF, and electrolyte disturbances such as hypomagnesemia. While needing more research, current risk factors include age, male sex, history of myocardial infarction or heart failure, hypertension, diabetes, obesity, and COPD. Treatments mostly include prophylaxis of repurposed drugs such as beta-blockers, statins, oral anticoagulants, antiarrhythmics, and Vitamin D and electrolyte supplementation. Autonomic denervation has also been a promising preventative measure for patients undergoing cardiac surgery. This critical review article provides an up-to-date and comprehensive summary of the pathophysiology of POAF, current clinical risk factors and management for POAF and discusses new pathways for further investigation.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Post-Operative Atrial Fibrillation: Current Treatments and Etiologies for a Persistent Surgical Complication

Lopes¹,

Agrawal²

2022

J Surg Res

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“…Moreover, the AFACT (Atrial Fibrillation Ablation and Autonomic Modulation via Thoracoscopic Surgery) study suggested that GP ablation in patients undergoing thoracoscopic surgery for advanced AF did not affect AF recurrence and resulted in more adverse effects ( 84 ). A variety of interventions are under investigation including sympathetic modulation via renal denervation, GP ablation, Botox, and CaCl 2 injection ( 85 ). Several surrogate markers of autonomic tone have been revealed in preclinical studies, and these can potentially be used as predictors of the treatment effect of autonomic modulation.…”

Section: Introductionmentioning

confidence: 99%

Research Opportunities in Autonomic Neural Mechanisms of Cardiopulmonary Regulation

Mehra

Tjurmina

Ajijola

et al. 2022

JACC: Basic to Translational Science

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“…5,65 Recent studies also showed a reduction in POAF incidence in patients who underwent Calcium-induced autonomic denervation of the major atrial ganglionated plexi or Botulinum toxin injection in epicardial fat pads, during cardiac surgery. 66,67 Moreover, precise identification of patients at high risk for POAF, based on their substrate, could in the future even result in deployment of more rigorous preventive measures, such as pre-emptive AF-ablation during the initial cardiac procedure.…”

Section: Discussionmentioning

confidence: 99%

Role of pre-operative transthoracic echocardiography in predicting post-operative atrial fibrillation after cardiac surgery: a systematic review of the literature and meta-analysis

et al. 2021

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Aims This systematic review and meta-analysis aims to evaluate the role of pre-operative transthoracic echocardiography in predicting post-operative atrial fibrillation (POAF) after cardiac surgery. Methods and results Electronic databases were searched for studies reporting on pre-operative echocardiographic predictors of POAF in PubMed, Cochrane library, and Embase. A meta-analysis of echocardiographic predictors of POAF that were identified by at least five different publications was performed. Forty-three publications were included in this systematic review. Echocardiographic predictors for POAF included surrogate parameters for total atrial conduction time (TACT), structural cardiac changes, and functional disturbances. Meta-analysis showed that prolonged pre-operative PA-TDI interval [5 studies, Cohen’s d = 1.4, 95% confidence interval (CI) 0.9–1.9], increased left atrial volume indexed for body surface area (LAVI) (23 studies, Cohen’s d = 0.8, 95% CI 0.6–1.0), and reduced peak atrial longitudinal strain (PALS) (5 studies, Cohen’s d = 1.4, 95% CI 1.0–1.8), were associated with POAF incidence. Left atrial volume indexed for body surface was the most important predicting factor in patients without a history of AF. These parameters remained important predictors of POAF in heterogeneous populations with variable age and comorbidities such as coronary artery disease and valvular disease. Conclusion This meta-analysis shows that increased TACT, increased LAVI, and reduced PALS are valuable parameters for predicting POAF in the early post-operative phase in a large variety of patients.

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Calcium-Induced Autonomic Denervation in Patients With Post-Operative Atrial Fibrillation

Cited by 42 publications

References 26 publications

Post-Operative Atrial Fibrillation: Current Treatments and Etiologies for a Persistent Surgical Complication

Post-Operative Atrial Fibrillation: Current Treatments and Etiologies for a Persistent Surgical Complication

Research Opportunities in Autonomic Neural Mechanisms of Cardiopulmonary Regulation

Role of pre-operative transthoracic echocardiography in predicting post-operative atrial fibrillation after cardiac surgery: a systematic review of the literature and meta-analysis

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