Subclinical Hypothyroidism Might Increase the Risk of Transient Atrial Fibrillation After Coronary Artery Bypass Grafting

Park, Young Joo; Yoon, Ji Won; Kim, Kwang Il; Lee, You Jin; Kim, Kyung Won; Choi, Sung Hee; Lim, Soo; Choi, Dong Ju; Park, Kay-Hyun; Choh, Joong Haeng; Jang, Hak Chul; Kim, Seong Yeon; Cho, Bo Youn; Lim, Cheong

doi:10.1016/j.athoracsur.2009.03.032

Cited by 64 publications

(75 citation statements)

References 30 publications

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“…In this cohort, however, we observed decreased FT 3 concentrations to be associated with AF, similar to a small number of previous reports [25,26]. FT 3 concentrations and SPINA-GD activity inversely correlated with age and PA-TDI interval, two markers of impaired prognosis.…”

Section: Discussionsupporting

confidence: 62%

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Nonthyroidal Illness Syndrome in Cardiac Illness Involves Elevated Concentrations of 3,5-Diiodothyronine and Correlates with Atrial Remodeling

Dietrich¹,

Müller²,

Schiedat

et al. 2015

Eur Thyroid J

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Background: Although hyperthyroidism predisposes to atrial fibrillation, previous trials have suggested decreased triiodothyronine (T₃) concentrations to be associated with postoperative atrial fibrillation (POAF). Therapy with thyroid hormones (TH), however, did not reduce the risk of POAF. This study reevaluates the relation between thyroid hormone status, atrial electromechanical function and POAF. Methods: Thirty-nine patients with sinus rhythm and no history of atrial fibrillation or thyroid disease undergoing cardiac surgery were prospectively enrolled. Serum concentrations of thyrotropin, free (F) and total (T) thyroxine (T₄) and T₃, reverse (r)T₃, 3-iodothyronamine (3-T₁AM) and 3,5-diiodothyronine (3,5-T₂) were measured preoperatively, complemented by evaluation of echocardiographic and electrophysiological parameters of cardiac function. Holter-ECG and telemetry were used to screen for POAF for 10 days following cardiac surgery. Results: Seven of 17 patients who developed POAF demonstrated nonthyroidal illness syndrome (NTIS; defined as low T₃ and/or low T₄ syndrome), compared to 2 of 22 (p < 0.05) patients who maintained sinus rhythm. In patients with POAF, serum FT₃ concentrations were significantly decreased, but still within their reference ranges. 3,5-T₂ concentrations directly correlated with rT₃ concentrations and inversely correlated with FT₃ concentrations. Furthermore, 3,5-T₂ concentrations were significantly elevated in patients with NTIS and in subjects who eventually developed POAF. In multivariable logistic regression FT₃, 3,5-T₂, total atrial conduction time, left atrial volume index and Fas ligand were independent predictors of POAF. Conclusion: This study confirms reduced FT₃ concentrations in patients with POAF and is the first to report on elevated 3,5-T₂ concentrations in cardiac NTIS. The pathogenesis of NTIS therefore seems to involve more differentiated allostatic mechanisms.

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Section: Discussionsupporting

confidence: 62%

“…Two trials unexpectedly revealed low preoperative FT 3 concentrations and subclinical hypothyroidism to predict POAF [25,26]. However, experimental substitution therapy with TH in order to prevent POAF resulted in conflicting results [27].…”

Section: Introductionmentioning

confidence: 99%

Nonthyroidal Illness Syndrome in Cardiac Illness Involves Elevated Concentrations of 3,5-Diiodothyronine and Correlates with Atrial Remodeling

Dietrich¹,

Müller²,

Schiedat

et al. 2015

Eur Thyroid J

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“…Sairaku et al demonstrated that LA a‐ and v‐wave pressure and mean LA pressure were significantly higher in patients with subclinical hypothyroidism (TSH >4.5 mIU/L; mean, 5.99 mIU/L) than in those with euthyroidism 11. Park et al have reported a higher incidence of transient AF in patients with subclinical hypothyroidism, defined as TSH >4.1 mIU/L, after coronary artery bypass graft 12. These facts strongly indicate that even subclinical hypothyroidism induces deteriorating myocardium or vascular resistance, probably resulting in increasing atrial pressure and AF occurrence.…”

Section: Discussionmentioning

confidence: 99%

High‐Normal Thyroid‐Stimulating Hormone Shows a Potential Causal Association With Arrhythmia Recurrence After Catheter Ablation of Atrial Fibrillation

Morishima

Okumura²,

Morita

et al. 2018

JAHA

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BackgroundHypothyroidism has been shown to contribute to enhanced atrial arrhythmogenesis, resulting in atrial fibrillation (AF) development in animal models and clinical populations. We aimed to elucidate whether high thyroid‐stimulating hormone (TSH) levels are related to outcomes of catheter ablation of AF.Methods and ResultsOf 477 consecutive patients who underwent first‐time pulmonary vein isolation–based radiofrequency catheter ablation of AF, 456 with TSH above the lower limit of the normal range (age, 65.5±9.9 years; men, 73.9%; paroxysmal AF, 56.8%) were analyzed for this study. Atrial tachyarrhythmia recurrence for 3 years was compared across groups with hypothyroidism (n=23) and TSH quartile groups with euthyroidism (normal‐range TSH levels, n=433). Atrial tachyarrhythmia recurrence occurred in 179 patients (39%) after the first session. Patients with hypothyroidism had increased recurrence compared with patients with normal TSH levels (crude hazard ratio, 3.14 after the last session; P=0.001). When focusing on patients with normal TSH levels, recurrence‐free survivals after both the first and last sessions were significantly reduced in euthyroid patients with the highest quartile of TSH levels (quartile 4) compared with others (quartiles 1–3). Cox regression analysis identified high TSH levels as an independent predictor of atrial tachyarrhythmia recurrence after both the first (adjusted hazard ratio, 1.51; P=0.018) and last (adjusted hazard ratio, 1.86; P=0.023) sessions. The difference was more pronounced in patients with paroxysmal AF than in those with nonparoxysmal AF.ConclusionsNot only hypothyroidism but also high‐normal TSH levels may be an independent predictor of atrial tachyarrhythmia recurrence after catheter ablation of AF.

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“…32,33 Other effects on the heart include a slowed left ventricular relaxation time, left ventricular systolic dysfunction with exercise, increased arterial stiffness, altered coagulation parameters, and impaired endothelial function 25,34,35 as well as greater risk of transient atrial fibrillation after coronary artery bypass graft. 36 Older patients are particularly susceptible to skeletal muscle dysfunction, altered cognitive capacity, depression, and reduced quality of life. Neuromuscular complaints and altered manual muscle testing are more frequent in subclinical hypothyroidism.…”

Section: The Morbidity and Mortality Of Subclinical Hypothyroidismmentioning

confidence: 99%

Subclinical Hypothyroidism in the Elderly: To Treat or Not to Treat?

Mooradian

2011

American Journal of Therapeutics

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Aging is associated with a host of alterations in thyroid gland structure and function. Some of these changes have favorable effects on longevity, whereas others are maladaptive and contribute to a decline in health and quality of life. An area of particular controversy is the diagnosis and management of subclinical hypothyroidism in the elderly. The clinical diagnosis of hypothyroidism in the elderly is difficult, because many signs and symptoms associated with hypothyroidism are commonly present in euthyroid elderly individuals. The biochemical profile of subclinical hypothyroidism includes normal serum levels of thyroid hormones with mildly elevated serum thyrotropin concentrations in the range of 4.5 to 10 mIU/L. In this article, the epidemiology of subclinical hypothyroidism in the elderly is reviewed, the potential advantages of mild hypothyroidism in people over the age of 75 years are discussed, and some guidelines for screening and management of this common thyroid dysfunction are suggested.

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Subclinical Hypothyroidism Might Increase the Risk of Transient Atrial Fibrillation After Coronary Artery Bypass Grafting

Cited by 64 publications

References 30 publications

Nonthyroidal Illness Syndrome in Cardiac Illness Involves Elevated Concentrations of 3,5-Diiodothyronine and Correlates with Atrial Remodeling

Nonthyroidal Illness Syndrome in Cardiac Illness Involves Elevated Concentrations of 3,5-Diiodothyronine and Correlates with Atrial Remodeling

High‐Normal Thyroid‐Stimulating Hormone Shows a Potential Causal Association With Arrhythmia Recurrence After Catheter Ablation of Atrial Fibrillation

Subclinical Hypothyroidism in the Elderly: To Treat or Not to Treat?

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