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

Abstract

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.

Hemodynamic parameters predict the risk of atrial fibrillation after cardiac surgery in adults

“…Their conclusion appears to be contrary to ours, and the difference in disease models and preoperative pathophysiological changes may contribute to the different mechanisms of POAF. Our research showed that elevated PASP was an independent predictor of POAF and was in accordance with a retrospective study that suggested that pulmonary hypertension, as evaluated by transthoracic echocardiography, was associated with an increased prevalence of POAF . The potential mechanism can be explained as 2 aspects: (1) In some patients, the simultaneously elevated PASP and PCWP may both reflect the overloading of left heart, which was mostly recognized to be responsible for the occurrence of POAF.…”

“…Our research showed that elevated PASP was an independent predictor of POAF and was in accordance with a retrospective study that suggested that pulmonary hypertension, as evaluated by transthoracic echocardiography, was associated with an increased prevalence of POAF. 21 The potential mechanism can be explained as 2 aspects: (1) In some patients, the simultaneously elevated PASP and PCWP may both reflect the overloading of left heart, which was mostly recognized to be responsible for the occurrence of POAF. (2) In other patients with elevated PASP but normal PCWP, the overloading of left heart may not be the main cause of POAF.…”

Low-Frequency Fluctuations Amplitude Signals Exhibit Abnormalities of Intrinsic Brain Activities and Reflect Cognitive Impairment in Leukoaraiosis Patients

“…All participants were instructed to complete a comprehensive neuropsychological battery. Global mental functioning was assessed through the Chinese version of Mini Mental State Examination (MMSE) [13], the Clinical Dementia Rating scale (CDR) and the Beijing version of Montreal Cognitive Assessment (MoCA) [14], under the supervision of a physician. The subsequent neuropsychological battery was tested in 5 cognition domains: 1) memory, tested by the Auditory Verbal Learning (AVLT-delay recall) [15]; 2) visuospatial ability and attention, tested by the Symbol Digit Modalities Test (SDMT) [16]; 3) language, tested by the Category Verbal Fluency Test [17]; 4) processing speed, tested by the Stroop Test (Stroop B-time) [18] and the Trail Making Test A (TMTa) [19] and 5) executive function, tested by the Trail Making Test B-A (TMTba) and the Stroop Test (Stroop CB-time).…”

Role of red blood cell distribution width and epicardial fat in atrial fibrillation after cardiopulmonary bypass

“…In the present study, the lengths of hospital stay and ICU stay were significantly higher in patients with POAF. Age was an important predictor of developing POAF after cardiac surgery (12). The mean age of the patients in the present study was 63.8 ± 9.4 years, and the patients in the POAF group were significantly older than those in the sinus rhythm group (69.2 ± 8.3 years vs. 62.1 ± 9.1 years, respectively, p < 0.01).…”