Relationship between atrial histopathology and atrial fibrillation after coronary bypass surgery

Mariscalco, Giovanni; Engström, Karl Gunnar; Ferrarese, Sandro; Cozzi, G; Bruno, Vito Domenico; Sessa, Fausto; Sala, A.

doi:10.1016/j.jtcvs.2006.01.040

Cited by 64 publications

(49 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…2,3,6,7 Despite attempts to account for confounding, it remains a distinct possibility that AF is associated with mortality because it occurs in patients with a severe profile of comorbidities. 2,6,7,10 All these investigations did not provide plausible direct mechanisms linking postoperative AF with late mortality, and the causes of death were not investigated. 2,3,6,7 Speculative causative mechanisms have been suggested, including hemodynamic ventricular compromise, occurrence of disabling strokes, and adverse proarrhythmic drug effects.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Atrial Fibrillation After Isolated Coronary Surgery Affects Late Survival

et al. 2008

Self Cite

View full text Add to dashboard Cite

Background-Atrial fibrillation (AF) after coronary artery bypass graft surgery is a difficult problem and a continuing source of morbidity and mortality. However, the prognostic implications of postoperative AF are still in dispute. Our aim was to ascertain the impact of AF after coronary artery bypass graft on postoperative survival and to assess its prognostic role in cause-specific mortality. Methods and Results-We conducted a prospective observational study of 1832 patients undergoing isolated coronary artery bypass graft between January 2000 and December 2005 at 2 cardiac surgery centers in northern Italy. Patients affected by postoperative AF were identified and followed up until death or study end (April 30, 2007). A total of 570 patients (31%) developed AF after coronary surgery. Patients affected by postoperative AF experienced a longer hospital stay (7 days [25th to 75th percentile, 7 to 10 days] versus 7 days [25th to 75th percentile, 6 to 8 days]; PϽ0.001). Hospital mortality also was higher in AF patients (3.3% versus 0.5%; PϽ0.001). On discharge, 1806 patients were alive; 143 were lost to follow-up. The remaining 1663 were followed up for a median of 51 months (25th to 75th percentile, 41 to 63 months); 126 of them died after a median of 14 months (25th to 75th percentile, 5 to 32 months). Long-term mortality rates were significantly higher for patients with postoperative AF (2.99 per 100 person-years; 95% confidence interval, 2.33 to 3.84; 61 deaths) compared with those without the arrhythmia (1.34 per 100 person-years; 95% confidence interval, 1.05 to 1.71; 65 deaths), with an adjusted hazard ratio of 2.13 (PϽ0.001) and 2.56 (Pϭ0.001) when also accounting for the prescription of warfarin at discharge. With Cox regression, patients with AF were shown to be at higher risk of dying from embolism (adjusted hazard ratio, 4.33; 95% confidence interval, 1.78 to 10.52) but not from other causes. Conclusions-Postoperative AF affects early and late mortality after isolated coronary artery bypass graft surgery. Patients affected by AF are at higher risk of fatal embolic events. Careful postoperative surveillance with a specific antiarrhythmic and antithrombotic prophylaxis, aimed at reducing AF and its complications, is recommended.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Only AF episodes lasting Ͼ15 minutes were considered. 10 Atrial flutter and tachycardia were disregarded because of their different mechanisms. 11 Amiodarone, either oral or intravenously administered, constituted the standard pharmacological treatment of AF.…”

Section: Patient Managementmentioning

confidence: 99%

Atrial Fibrillation After Isolated Coronary Surgery Affects Late Survival

et al. 2008

Self Cite

View full text Add to dashboard Cite

show abstract

“…8 -10 Increased amounts of fibrosis were seen in the atria of patients with AF as opposed to those patients in sinus rhythm. 10,11 Homogeneity conduction of atrial actuation depends not only on synchronized actuation of cardiocytes, but also on the concordance of matrix and cardiomyocyte. 12,13 Collagens I and III, the major matrix proteins of cardiocytes, constitute 85% of the content of the myocardial matrix.…”

Section: Discussionmentioning

confidence: 99%

TGF‐β1 Expression and Atrial Myocardium Fibrosis Increase in Atrial Fibrillation Secondary to Rheumatic Heart Disease

Xiao

Shu

et al. 2010

Clinical Cardiology

View full text Add to dashboard Cite

Background:Atrial fibrosis was considered a structural basis for the development and sustaining of atrial fibrillation (AF). Transforming growth factor‐β1 (TGF‐β1) was one of the main factors for accelerating collagen production. The contribution of TGF‐β1 in the pathogenesis of AF needs further investigation.Hypothesis:The altered expression and distribution of TGF‐β1 will be associated with the changes in atrial fibrosis in different types of AF patients with rheumatic heart disease (RHD).Methods:Right atrial specimens obtained from 38 RHD patients undergoing mitral valve replacement surgery were divided into 3 groups: the sinus rhythm group (n = 8), the paroxysmal AF group (pAF; n = 10), and the chronic AF group (cAF; AF lasting ≥ 6 mo; n = 20). The degree of atrial fibrosis, collagen content, serum levels, messenger RNA (mRNA), and protein expression of TGF‐β1 were detected.Results:The collagen content, serum level, TGF‐β1 mRNA, and protein expression of the atrial tissue increased gradually in sinus rhythm, for both pAF and cAF groups, respectively. A positive correlation between TGF‐β1 and the degree of atrial fibrosis was also demonstrated (P < 0.05).Conclusion:The TGF‐β1 expression in atrial tissue increased gradually in proportion to the degree of atrial fibrosis in AF and was associated with the type of AF, which suggests that TGF‐β1 is possibly involved in the pathogenesis of AF in RHD patients. Copyright © 2010 Wiley Periodicals, Inc.

show abstract

“…The incidence of postoperative AF was 28.3% which is similar to rates reported by previous studies. 24 Ten of 15 patients with post-AF converted spontaneously in-hospital. The results suggest that age, IBS%, and CVF in patients with post-AF were higher than in patients without post-AF.…”

Section: Ibs and Atrial Fibrosis Between Patients With And Without Pomentioning

confidence: 99%

Relationship Between Integrated Backscatter and Atrial Fibrosis in Patients with and Without Atrial Fibrillation Who Are Undergoing Coronary Bypass Surgery

Wang

Shen

Wang

et al. 2009

Clinical Cardiology

View full text Add to dashboard Cite

Objective: The purpose of this study was to investigate the relationship between the integrated backscatter (IBS) and atrial fibrosis, with and without atrial fibrillation (AF), in patients who are undergoing coronary bypass grafting (CABG). Methods: A total of 74 patients (18 preoperative AF, 56 sinus rhythm [SR]) with coronary artery disease undergoing CABG were included. The IBS of the left atrium (LA) posterior wall was acquired from transthoracic echocardiographic examination before surgery. Samples from the LA appendage were collected after opening the pericardium and quantitative assessment of atrial fibrosis was performed with collagen volume fraction (CVF). Postoperative AF was monitored with electrocardiographic telemetry in-hospital.Results: There was a positive relationship between age, IBS of the left atrial posterior wall indexed by pericardium (IBS%), and CVF by multivariate linear regression analysis (r = 0.612, p = 0.034; r = 0.887, p<0.001 respectively). The value of IBS%, LA dimension (LAD), and CVF values were higher in patients with preoperative AF than in patients with preoperative SR (p<0.001, p<0.01, p<0.001, respectively). The value of age, IBS%, and CVF in patients with postoperative AF were higher than in patients without postoperative AF (p = 0.029, p<0.001, p = 0.001 respectively). Conclusions: IBS of the LA posterior wall indexed by pericardium provides an objective quantitative measure of atrial fibrosis and correlates with postoperative AF in patients undergoing CABG surgery.

show abstract

Relationship between atrial histopathology and atrial fibrillation after coronary bypass surgery

Cited by 64 publications

References 32 publications

Atrial Fibrillation After Isolated Coronary Surgery Affects Late Survival

Atrial Fibrillation After Isolated Coronary Surgery Affects Late Survival

TGF‐β1 Expression and Atrial Myocardium Fibrosis Increase in Atrial Fibrillation Secondary to Rheumatic Heart Disease

Relationship Between Integrated Backscatter and Atrial Fibrosis in Patients with and Without Atrial Fibrillation Who Are Undergoing Coronary Bypass Surgery

Contact Info

Product

Resources

About