Post-operative atrial fibrillation after off-pump coronary artery bypass grafting

Lohchab, Shamsher Singh; Kumar, Ashwani

doi:10.1007/s12055-019-00849-4

Cited by 4 publications

(5 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the Framingham Heart Study, it was shown low magnesium level after cardiac surgery was an indication for the onset of POAF [ 23 , 24 ]. A meta-analysis showed that treating patients prophylactically with magnesium in the post-operative period only led to a statistically significant decrease in POAF [ 25 ], suggesting the use of intravenous magnesium as an alternative to prevent POAF. However, careful randomized clinical studies are required to determine the safety and duration of effect.…”

Section: Methodsmentioning

confidence: 99%

“…POAF presents a major risk for any cardiac surgery; however, some surgeries are more likely to induce POAF. Specifically, patients who undergo combined surgeries, such as a combined valve and coronary artery bypass graft (CABG) surgeries, are twice as likely to develop POAF, up to 60% [ 25 ]. CABG surgeries alone lead to a higher risk for developing POAF, and patients experience an increased risk of other complications from POAF [ 26 , 27 ].…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

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

Lopes¹,

Agrawal²

2022

J Surg Res

View full text Add to dashboard Cite

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.

show abstract

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

View full text Add to dashboard Cite

show abstract

“…AF is generally seen more frequently in patient populations with heart failure with a reported incidence rate of 13-27% 36 . Post-myocardial infarction scarring was shown to be a strong predictor of low EF and higher LV volume 37 . Neilan et al 38 evaluated the effects of myocardial scarring on AF in hypertrophic cardiomyopathy.…”

Section: Discussionmentioning

confidence: 97%

Predictability of Atrial Fibrillation in Patients having Coronary Artery Bypass Graft Surgery, Based on Selvester Score

Uysal¹,

Kuyumcu²

2021

NKTD

View full text Add to dashboard Cite

Aim: Patients having coronary artery bypass graft (CABG) surgery are influenced mostly by atrial fibrillation (AF), with the peak incidence of 16-44%. Due to post-operative AF (POAF), patients may be hospitalized for longer periods, require intensive care unit care again, necessitate more healthcare resources and even undergo congestive heart failure or stroke. Recent studies have shown that the size of the ventricular scar might be used as an indicator in the pathophysiology of AF. Selvester score was developed for the measurement of myocardial scar volume in patients with abnormal ventricular conduction, reporting its prognostic value in AF. Thus, we aim to investigate a likely relationship of POAF and the Selvester scoring system. Materials and Methods:This retrospective study included 180 patients with CABG from 2017 August to 2018 September. The obtained data had been analyzed in separate cohort of patients with POAF (n=50) and with post-operative sinus rhythm (PSR) (n=130). Intergroup comparisons were made using Selvester scores in particular. Results:The POAF group had higher Selvester scores (p<0.001), score of SYNTAX (p=0.039), serum high-sensitivity C-reactive protein levels (p=0.026), mean age (p<0.001), hypertrophy of left ventricul (LVH) (p=0.019) and hypertension (p=0.007) and decrased ejection fraction (LVEF) (p<0.001) than the PSR group. Logistic multivariable regression analyses showed that there were an independent association of LVH (p=0.041), LVEF (p=0.004), older age (p=0.008) and higher Selvester score (p<0.001) with POAF. Conclusion:Higher scores in Selvester scoring system are closely related to POAF, and Selvester score is a potential indicator for POAF.

show abstract

“…Some surgeries are more likely to induce POAF [ 24 ]. Specifically, patients who undergo combined surgeries, such as combined valve and coronary artery bypass graft (CABG) surgeries, are twice as likely to develop POAF, up to 60% [ 25 ]. When types of surgery (diseases) were analyzed in terms of higher dosing ratios of protamine-to-heparin ( Table 2 ), only valvular disorders were marginally associated with POAF ( p = 0.04).…”

Section: Discussionmentioning

confidence: 99%

Association of postoperative atrial fibrillation with higher dosing ratios of protamine-to-heparin

Yamada

J²,

Kambara³

et al. 2023

J Extra Corpor Technol

View full text Add to dashboard Cite

Background: Postoperative atrial fibrillation (POAF) is defined as new-onset AF in the immediate postoperative period. The relatively high incidence of POAF after cardiac surgery is well described, but pathophysiological mechanisms underlying the initiation, maintenance, and progression of POAF may be multifactorial and have not yet been comprehensively characterized. One of the mechanisms includes altered Ca2+ kinetics. Accumulating evidence has suggested that altered atrial cytosolic calcium handling contributes to the development of POAF, protamine reversibly modulates the calcium release channel/ryanodine receptor 2 (RyR2) and voltage-dependent cardiac RyR2. However, it is currently unknown whether such abnormalities contribute to the arrhythmogenic substrate predisposing patients to the development of POAF. Methods: We have retrospectively analyzed 147 patients who underwent cardiac surgery with cardiopulmonary bypass support. Of these, 40 patients were excluded from the analysis because of pre-existing AF. All patients received heparin followed by protamine at different dosing ratios of protamine-to-heparin, depending on the periods studied. Results: The dosing ratio of protamine-to-heparin = 1.0 was compared with higher dosing ratios of protamine-to-heparin >1.0 up to 1.7. POAF developed in 15 patients (15/107 = 14%), of these, 5 out of 57 patients (33.3%) in the dosing ratio of protamine-to-heparin = 1.0 and 10 out of 35 patients (66.7%) in the higher dosing ratios of protamine-to-heparin. Statistical significance was observed in patients with higher dosing ratios of protamine-to-heparin, compared with the dosing ratio of protamine-to-heparin = 1.0 (odds ratio = 3.890, 95% CI = 1.130–13.300, p-value = 0.031). When types of diseases were analyzed in terms of higher dosing ratios of protamine-to-heparin, only valvular disorders were significantly associated with POAF (p = 0.04). Conclusions: Protamine is clinically utilized to reverse heparin overdose and has been shown to display immunological and inflammatory alterations. However, its association with POAF has not been reported. Our results provide evidence that higher dosing ratios of protamine-to-heparin may increase the incidence of POAF.

show abstract

Post-operative atrial fibrillation after off-pump coronary artery bypass grafting

Cited by 4 publications

References 10 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

Predictability of Atrial Fibrillation in Patients having Coronary Artery Bypass Graft Surgery, Based on Selvester Score

Association of postoperative atrial fibrillation with higher dosing ratios of protamine-to-heparin

Contact Info

Product

Resources

About