Plasma B-Type Natriuretic Peptide Levels Predict Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery

Abstract

Background-Postoperative (postop) atrial fibrillation (AF) occurs in up to 60% of patients after cardiac surgery, leading to longer hospital stays and increased healthcare costs. Recently, B-type natriuretic peptide (BNP) has been reported to predict occurrence of nonpostoperative AF. This study evaluates whether elevated preoperative (preop) plasma BNP levels predict the occurrence of postop AF. Methods and Results-One hundred eighty-seven patients with no history of atrial arrhythmia who had a preoperative BNP level and had undergone cardiac surgery were identified. Their records were reviewed, and postoperative ECG and telemetry strips were analyzed for AF until the time of discharge. Postop AF was documented in 80 patients (42.8%). AF patients were older (68Ϯ11 versus 64Ϯ14 years, Pϭ0.04), but there was no difference in sex distribution, hypertension, left ventricular (LV) function, LV hypertrophy (LVH), left atrial size, history of coronary artery disease (CAD), or ␤-blocker use. Preop plasma BNP levels were higher in the postop AF patients (615 versus 444 pg/mL, Pϭ0.005). After adjustment for age, sex, type of surgery, hypertension, LV function, LVH, left atrial size, CAD, and ␤-blocker use, the odds ratios of postop AF according to increasing quartiles, compared with patients with lowest quartile, were 1.8, 2.5, and 3.7 (P trend ϭ0.03). Conclusions-An elevated preop plasma BNP level is a strong and independent predictor of postop AF. This finding has important implications for identifying patients at higher risk of postop AF who could be considered for prophylactic antiarrhythmic or ␤-blocker therapy.

Preoperative plasma brain natriuretic peptide level is an independent predictor of postoperative atrial fibrillation following off-pump coronary artery bypass surgery

“…Wazni et al [27] reported that preoperative BNP levels predicted postoperative AF following cardiac surgery. As they suggested, an elevated BNP level has been shown to be associated with AF in some reports [28,29].…”

Factors associated with the development of atrial fibrillation in patients with rheumatic mitral stenosis

“…Inflammation and elevated left ventricular enddiastolic pressure has been shown to be associated with AF [2][3][4][5][6][7][8][9][10]. In the previous studies, several clinical, echocardiographic parameters as well as high-sensitivity C-reactive protein (HsCRP), as a marker of inflammation, have been shown to be associated with development of AF in patients with rheumatic MS [1,11,12].…”

The Relationship between the Changes of Blood NT-proBNP Levels and Postoperative Atrial Fibrillation Occurance in Coronary Artery By-Pass Grafting Surgery Patients

“…The incidence of postoperative AF in CABG patients has been reported as 20% -40% of patients [2] [3]. The patient's pre-existing arrhythmia [4], advanced age [4], preoperative beta-blocker medication [5], hypertension, left ventricle dysfunction, angina pectoris, MI, right coronary artery stenosis [5] AF: Atrial Fibrillation, NT-proBNP: N-terminal natriuretic peptide, T1: pre-operation time, T2:1st day after the operation, T3: 3rd day after the operation, T4: 5th day after the operation (T4). P < 0.05 was evaluated at a level of significance.…”

“…A multy-variate analyses demonstrated that hypertension, ReDo CABG were found to be a significant risk factors for NOAF in previous studies. Also, prolonged aortic cross clamping and longer operation [19], anesthesics, insufficient ventilation [4], cardioplegic arrest are the risk factors of AF. In our study, if patients' cross clamp time and CPB durations increased in On-Pump group, these patients were excluded from the study to provide any confusing of the reason of AF occurrence.…”

“…The incidence of postoperative AF after CABG has been reported as 20% -40% of patients [2] [3]. The patient's pre-existing arrhythmia [4], advanced age [4], preoperative beta-blocker medication [5], hypertension, left ventricule dysfunction, angina pectoris, myocard infarction (MI), and right coronary artery stenosis [5] [6] are accepted the important factors for postoperative AF risk. Multiple mechanisms may be involved in postoperative atrial fibrillation including myocardial enzyme and/or high brain natriuretic peptid levels postoperatively.…”