Postoperative Atrial Fibrillation

Yadava, Mrinal; Hughey, Andrew B.; Crawford, Thomas

doi:10.1016/j.hfc.2015.08.023

Cited by 71 publications

(31 citation statements)

References 115 publications

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“…In addition, the mechanisms of postoperative AF may be more complex and are not entirely dependent on the presence of abnormal autonomic nerve activities. 19 A more recent study 20 shows that botulinum toxin injection into epicardial fat pads during coronary artery bypass graft surgery provided substantial suppression of atrial tachyarrhythmias postoperatively. These findings suggest that increased burst ICNA discharges maybe causally related to the development of postoperative atrial arrhythmias, including AF.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous recordings of intrinsic cardiac nerve activity and skin sympathetic nerve activity from human patients during the postoperative period

et al. 2017

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Background Intrinsic cardiac nerve activities (ICNA) and the skin nerve activities (SKNA) are both associated with cardiac arrhythmias in dogs. Objective To test the hypothesis that ICNA and SKNA correlate with postoperative cardiac arrhythmias in humans. Methods Eleven patients (60±13 years old; 4 female) were enrolled in this study. Electrical signals were simultaneously recorded from electrocardiogram (ECG) patch electrodes on the chest wall and from two temporary pacing wires placed during open heart surgery on the left atrial epicardial fat pad. The signals were filtered to display SKNA and ICNA. Premature atrial contractions (PAC) and premature ventricular contractions (PVC) were manually determined. The SKNA and ICNA of the first 300 min of each patient were calculated min-by-min to determine baseline average amplitudes of nerve activities and to determine their correlation with arrhythmia burden. Results We processed 1365±973 min of recording per patient. Low-amplitude SKNA and ICNA were present at all time, while the burst discharges were observed much less frequently. Both SKNA and burst ICNA were significantly associated with the onset of PACs and PVCs. Baseline average ICNA (aICNA), but not SKNA (aSKNA), had a significant association with PAC burden. The correlation coefficient (r) between aICNA and PAC burden was 0.78 (P<0.01). A patient with the greatest aICNA developed postoperative atrial fibrillation. Conclusions ICNA and SKNA can be recorded from human patients in the postoperative period. Baseline magnitude of ICNA correlates with PAC burden and development of postoperative atrial fibrillation.

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Section: Discussionmentioning

confidence: 99%

Simultaneous recordings of intrinsic cardiac nerve activity and skin sympathetic nerve activity from human patients during the postoperative period

et al. 2017

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“…Such events are known to impact healthcare costs, morbidity and mortality, postoperative discomfort, and tachycardia, necessitating rhythm reversal and prolonging ICU stays or forcing readmission. Hence, perioperative strategies to minimize occurrences of POAF are of great importance and are constantly under study [4, 5]. …”

Section: Introductionmentioning

confidence: 99%

Preoperative carbohydrate load and intraoperatively infused omega-3 polyunsaturated fatty acids positively impact nosocomial morbidity after coronary artery bypass grafting: a double-blind controlled randomized trial

Feguri

Lima

Borges

et al. 2017

Nutr J

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BackgroundA strategy of limited preoperative fasting, with carbohydrate (CHO) loading and intraoperative infusion of omega-3 polyunsaturated fatty acids (ω-3 PUFA), has seldom been tried in cardiovascular surgery. Brief fasting, followed by CHO intake 2 h before anesthesia, may improve recovery from CABG procedures and lower perioperative vasoactive drug requirements. Infusion of ω-3 PUFA may reduce occurrences of postoperative atrial fibrillation (POAF) and shorten hospital stays. The aim of this study was to assess morbidity (especially POAF) in ICU patients after coronary artery bypass grafting (CABG)/cardiopulmonary bypass (CPB) in combination, if preoperative fasts are curtailed in favor of CHO loading, and ω-3 PUFA are infused intraoperatively.MethodsFifty-seven patients undergoing CABG were randomly assigned to receive 12.5% maltodextrin (200 ml, 2 h before anesthesia), without infusing ω-3 PUFA (CHO, n = 14); water (200 ml, 2 h before anesthesia), without infusing ω-3 PUFA (controls, n = 14); 12.5% maltodextrin (200 ml, 2 h before anesthesia) plus intraoperative ω-3 PUFA (0.2 mcg/kg) (CHO + W3, n = 15); or water (200 ml, 2 h before anesthesia) plus intraoperative ω-3 PUFA (0.2 mcg/kg) (W3, n = 14). Perioperative clinical variables and mortality were analyzed, examining the incidence of POAF, as well as the need for inotropic vasoactive drugs during surgery and in ICU.ResultsTwo deaths occurred (3.5%), but there were no instances of bronchoaspiration and mediastinitis. Neither ICU stays nor total postoperative stays differed by group (P > 0.05). Patients given preoperative CHO loads (CHO and CHO + W3 groups) experienced fewer instances of hospital infection (RR = 0.29, 95%CI 0.09–0.94; P = 0.023) and were less reliant on vasoactive amines during surgery (RR = 0.60, 95% CI 0.38–0.94; P = 0.020). Similarly, the number of patients requiring vasoactive drugs while recovering in ICU differed significantly by group (P = 0.008), showing benefits in patients given CHO loads. The overall incidence of POAF was 29.8% (17/57), differing significantly by group (P = 0.009). Groups given ω-3 PUFA (W3 and CHO + W3 groups) experienced significantly fewer instances of POAF (RR = 4.83, 95% CI 1.56–15.02; P = 0.001).ConclusionPreoperative curtailment of fasting was safe in this cohort. When implemented in conjunction with CHO loading and infusion of ω-3 PUFA during surgery, expedited recovery from CABG with CPB was observed.Trial registrationNCT: 03017001

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“…Патогенез ПОФП остается неопределенным и, вероятно, является мультифакториальным. Предполагается, что инициирующий механизм развития ФП в этой популяции пациентов заключается во множественном повторном входе волны возбуждения (формировании круговой волны возбуждения), распространяющейся по предсердиям, который часто провоцируется предсердной экстрасистолией, возникающей в областях замедления и однонаправленного блока проведения импульса [5,6]. Некоторые авторы продемонстрировали влияние этого вида аритмии на клинические и экономические профили [16][17][18][19].…”

Section: Discussionunclassified

The role of biatrial pacing in prevention of atrial fibrillation after coronary artery bypass grafting

Bockeriа¹,

Bockeria²,

Fatulaev³

et al. 2018

Ann aritm

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Postoperative Atrial Fibrillation

Cited by 71 publications

References 115 publications

Simultaneous recordings of intrinsic cardiac nerve activity and skin sympathetic nerve activity from human patients during the postoperative period

Simultaneous recordings of intrinsic cardiac nerve activity and skin sympathetic nerve activity from human patients during the postoperative period

Preoperative carbohydrate load and intraoperatively infused omega-3 polyunsaturated fatty acids positively impact nosocomial morbidity after coronary artery bypass grafting: a double-blind controlled randomized trial

The role of biatrial pacing in prevention of atrial fibrillation after coronary artery bypass grafting

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