Serum potassium level and risk of postoperative atrial fibrillation in patients undergoing cardiac surgery

Auer, Johann; Weber, Thomas; Baldassano, Robert N.; Lamm, Gudrun; Eber, Bernd

doi:10.1016/j.jacc.2004.05.035

Cited by 31 publications

(18 citation statements)

References 10 publications

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“…Although hypokalemia and hypomagnesemia are commonly thought to increase risk for postoperative atrial fibrillation (POAF) after cardiac surgery (1, 2), no large studies have evaluated the actual postoperative changes in electrolyte levels or their true clinical relevance to POAF risk.…”

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confidence: 99%

Potassium and Magnesium Supplementation Do Not Protect Against Atrial Fibrillation After Cardiac Operation: A Time-Matched Analysis

Lancaster

Schill

Greenberg

et al. 2016

The Annals of Thoracic Surgery

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Introduction Despite a lack of demonstrated efficacy, potassium and magnesium supplementation are commonly thought to prevent postoperative atrial fibrillation (POAF) after cardiac surgery. Our aim was to evaluate the natural time course of electrolyte level changes after cardiac surgery and their relationship to POAF occurrence. Methods Data were reviewed from 2041 adult patients without preoperative AF who underwent CABG and/or valve surgery between 2009 and 2013. In patients with postoperative AF, the plasma potassium and magnesium levels nearest to the first AF onset time were compared to time-matched electrolyte levels in patients without AF. Results POAF occurred in 752 patients (36.8%). At the time of AF onset or the matched time point, patients with POAF had higher potassium (4.30 vs. 4.21 mmol/L, p<0.001) and magnesium (2.33 vs. 2.16 mg/dL, p<0.001) levels than controls. A stepwise increase in AF risk occurred with increasing potassium or magnesium quintile (p<0.001). On multivariate logistic regression analysis, magnesium level was an independent predictor of POAF (OR 4.26, p<0.001), in addition to age, Caucasian race, preoperative beta blocker use, valve surgery, and postoperative pneumonia. Prophylactic potassium supplementation did not reduce the POAF rate (37 vs. 37%, p=0.813), while magnesium supplementation was associated with increased POAF (47 vs. 36%, p=0.005). Conclusion Higher serum potassium and magnesium levels were associated with increased risk for POAF after cardiac surgery. Potassium supplementation was not protective against POAF, while magnesium supplementation was even associated with increased POAF risk. These findings help explain the poor efficacy of electrolyte supplementation in POAF prophylaxis.

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mentioning

confidence: 99%

Potassium and Magnesium Supplementation Do Not Protect Against Atrial Fibrillation After Cardiac Operation: A Time-Matched Analysis

Lancaster

Schill

Greenberg

et al. 2016

The Annals of Thoracic Surgery

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“…The upward trend of serum K levels in all 3 groups after tolvaptan administration was not considered to be due to the action of tolvaptan but rather was the result of aggressive correction and supplementation to raise serum K levels above 4 mEq/L; this was in consideration of the fact that low serum K levels following open heart surgery increase the incidence of atrial fibrillation. 19,20) We do not consider the serum K level as a good predictor of hypernatremia following open heart surgery.…”

Section: Discussionmentioning

confidence: 99%

A Safety and Efficacy Study of Tolvaptan Following Open Heart Surgery in 109 Cases

et al. 2016

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SummaryThis study was conducted to evaluate the safety and efficacy of tolvaptan following open heart surgery. We retrospectively reviewed 109 patients who were administered tolvaptan following open heart surgery between August 2011 and July 2014. We divided the patients according to their urine output index (amount of urine output/body surface area) into tertiles as follows: T1 (low responders; n = 36), T2 (intermediate responders; n = 36), and T3 (high responders; n = 37). No fatal adverse events were observed following tolvaptan administration. The factors that showed a significant difference among the 3 groups were body surface area (BSA) and preoperative body weight. Body weight rapidly decreased and a greater increase in the serum sodium level was observed on day 1 in the T3 group than in the other 2 groups. No decrease in blood pressure and no significant differences in the occurrence of atrial fibrillation were observed among the 3 groups during tolvaptan administration.Tolvaptan can be safely and effectively administered to increase the urine output without adversely affecting the cardiovascular system or renal function following open heart surgery. However, careful attention is required regarding the possibility of a rapid increase in the serum sodium level so it is important to monitor changes in serum Na levels. ( open heart surgery in recent years, volume control is one of the most important factors in the perioperative management of open heart surgery. Tolvaptan, a vasopressin V2-receptor antagonist, is available as a diuretic drug that can be used in the treatment of fluid accumulation in heart failure. Several studies have reported the efficacy of tolvaptan in patients with chronic congestive heart failure and acute heart failure. [1][2][3][4][5] According to previous reports, the use of tolvaptan for acute heart failure at an early stage of hospitalization prevents exacerbation of acute kidney injury, improves patient prognosis, 6) is superior to carperitide in terms of treatment cost of acute heart failure, 7) and is effective for correcting hyponatremia. [8][9][10] Although there are case reports indicating the efficacy of tolvaptan after open heart surgery, the number of patients reported is small. [11][12][13][14] Open heart surgery using cardiopulmonary bypass is often followed by symptoms such as circulatory inflammatory response, capillary hyperpermeability due to low body temperature, decreased intravascular colloid oncotic pressure due to hemodilution, and stromal edema as a result of decreased lymph flow.15) Blood vasopressin concentration also increases after cardiac surgery because of hypotension during cardiopulmonary bypass and sympathetic nerve activation caused by operative stress.16) Therefore, it is believed that reabsorption of water in the collecting tubules is excessive following open heart surgery. Because the diuretic effect of tolvaptan reduces the accumulation of intercellular fluid through an increase in the serum Na level or a difference in osmotic pressure, tolvaptan ...

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“…Its presence is significantly associated with postoperative complications such as hypoxia, hypovolemia, sepsis and electrolytic disorders 29,30 . It is also related to the following factors: higher incidence of gastrointestinal complications, kidney failure, cerebrovascular accident (CVA), heart failure (HF), need for antiarrhythmic drugs after hospital discharge and increase in mortality over a period that ranges from thirty days to six months after the surgery 16,26,28,31 .…”

Section: Discussionmentioning

confidence: 99%

Fibrilação atrial no pós-operatório de cirurgia cardíaca

Ferro¹,

Oliveira²,

Nunes³

et al. 2009

Arq. Bras. Cardiol.

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SummaryAtrial fibrillation (AF) is an arrhythmia frequently seen in the postoperative period of cardiac surgery. In this context, it is associated with the presence of comorbidities, longer length of hospital stay, and higher costs related to surgery.The mechanisms involved in the genesis of AF in the postoperative period of cardiac surgery (AFPO) are different from those causing paroxysmal AF. Knowledge of these mechanisms permits the use of efficient measures to reduce the incidence of this arrhythmia.According to recommendations of the literature, treatment is efficient and safe, because the rates of reversion to sinus rhythm are high and complications are reduced, and it is not associated with a high frequency of side effects.

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Serum potassium level and risk of postoperative atrial fibrillation in patients undergoing cardiac surgery

Cited by 31 publications

References 10 publications

Potassium and Magnesium Supplementation Do Not Protect Against Atrial Fibrillation After Cardiac Operation: A Time-Matched Analysis

Potassium and Magnesium Supplementation Do Not Protect Against Atrial Fibrillation After Cardiac Operation: A Time-Matched Analysis

A Safety and Efficacy Study of Tolvaptan Following Open Heart Surgery in 109 Cases

Fibrilação atrial no pós-operatório de cirurgia cardíaca

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