The impact of volume substitution on post‐operative atrial fibrillation

Schnaubelt, Sebastian; Pilz, A; Koller, Lorenz; Kazem, Niema; Hofer, Felix; Fleck, Tatjana; Laufer, Günther; Steinlechner, Barbara; Niessner, Alexander; Sulzgruber, Patrick

doi:10.1111/eci.13456

Cited by 8 publications

(6 citation statements)

References 28 publications

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“…Pain, especially unrelieved pain, could be a trigger for atrial fibrillation. However, in a placebo-controlled clinical trial, Dexmedetomidine for reduction of atrial fibrillation and delirium after cardiac surgery (DECADE), the levels of pain and opioid consumption was unremarkable between patients who developed atrial fibrillation post-operation versus patients who did not [ 20 ]. Because of the multifactorial nature of atrial fibrillation and delirium, the findings from this study suggest no association between opioid use and atrial fibrillation and delirium.…”

Section: Methodsmentioning

confidence: 99%

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

Lopes¹,

Agrawal²

2022

J Surg Res

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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.

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Section: Methodsmentioning

confidence: 99%

“…In a recent study 43% of patients developed POAF and showed increased post-operative fluid balance and M-terminal pro-brain natriuretic peptide (NT-ProBNP). Also, anemia pre-operation led to increased transfusion volumes, and suggests that POAF may be triggered by global cardiac strain [ 20 ].…”

Section: Methodsmentioning

confidence: 99%

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

Lopes¹,

Agrawal²

2022

J Surg Res

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“…(3,10,21) It seems, that not only intraoperative blood loss per se but also the subsequent intra-and postoperative red blood cell or platelet transfusion fosters POAF development. (22) Stretch of myocardial tissue by subsequent volume load enhances cardiac strain as a stressor for POAF.…”

Section: Inflammation Cardiac Strain and Postoperative Atrial Fibrillationmentioning

confidence: 99%

“…3,10,21 It seems that not only intraoperative blood loss per se but also the subsequent intra-and postoperative red blood cell or platelet transfusion fosters POAF development. 22 Stretch of myocardial tissue by subsequent volume load enhances cardiac strain as a stressor for POAF. Assuming the mentioned multifactorial approach, in line with a potential impact on cardiac strain, patients with higher preoperative GDF-15 levels experienced nearly 1.5 times more often POAF.…”

Section: Inflammation Cardiac Strain and Postoperative Atrial Fibrillationmentioning

confidence: 99%

The Prognostic Potential of Growth Differentiation Factor-15 on Bleeding Events and Patient Outcome after Cardiac Surgery—A Prospective Cohort Study

et al. 2021

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Background: GDF-15 (growth/differentiation factor 15) is induced by myocardial stretch, volume overload, inflammation and oxidative stress. Its expression is tightly linked with cardiovascular events as well as the risk for major bleeding and all-cause mortality. The present study aimed to elucidate the prognostic potential of GDF-15 in patients after cardiac surgery. Methods: 504 patients undergoing elective cardiac valve and/or coronary artery bypass graft surgery were prospectively enrolled. GDF-15 levels were measured prior surgery to evaluate the impact on bleeding events, thromboembolic events and mortality. Results: Preoperative GDF-15 was associated with the primary endpoint of intra- and postoperative red blood cell transfusion (for bleeding risk factors adjusted [adj] OR [odds ratio] per 1-SD [standard deviation] of 1.62 [95%CI:1.31-2.00]; p<0.001). Higher concentrations of GDF-15 were observed in patients reaching the secondary endpoint of major or clinically relevant minor bleeding (for bleeding risk factors adj. OR per 1-SD of 1.70 [95%CI:1.05-2.75]; p=0.030) during the 1st postoperative year, but not for thromboembolic events. GDF-15 was a predictor for cardiovascular mortality (for comorbidities adj. HR [hazard ratio] per 1-SD of 1.67 [95%CI:1.23-2.27]; p=0.001) and all-cause mortality (for comorbidities adj. HR per 1-SD of 1.55 [95%CI:1.19-2.01]; p=0.001). A combined risk model of GDF-15 and EuroSCORE II outperformed the EuroSCORE II alone for long-term survival (c-index: 0.75 [95%CI: 0.70-0.80], p=0.046; net reclassification improvement: 33.6%, p<0.001). Conclusion: Preoperative GDF-15 concentration is an independent predictor for intra- and postoperative major bleeding, major bleeding during the first year and for long-term cardiovascular or all-cause mortality after cardiac surgery.

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“…Furthermore, invasive electrophysiological examination after cardiac surgery is time‐consuming and potentially harmful in the early post‐operative phase and, thus, not feasible in daily practice. Several factors have been identified to increase the risk of NOAF: (i) vasoactive agents used for haemodynamic stabilization, 5,8 (ii) poor post‐operative pain control, 9 and (iii) post‐operative fluid overload 10,11 . Additional factors contribute to the local myocardial inflammation due to reperfusion injury after cardiopulmonary bypass 12 .…”

Section: Introductionmentioning

confidence: 99%

Non‐invasive evaluation of new‐onset atrial fibrillation after cardiac surgery: a protocol for the BigMap study

et al. 2022

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Aims New-onset atrial fibrillation (NOAF) is the most common complication after cardiac surgery, occurring in 25-50% of patients. It is associated with post-operative stroke, increased mortality, prolonged hospital length of stay, and higher treatment costs. Previous small observational studies have identified the left atrium as a source of the electrical rotors and foci maintaining NOAF, but confirmation by a large prospective clinical study is still missing. The aim of the proposed study is to investigate whether the source of NOAF lies in the left atrium. The correct identification of NOAF-maintaining structures in cardiac surgical patients might offer potential therapeutic targets for prophylactic perioperative ablation strategies. Methods and resultsThis is a prospective single-centre observational study of patients developing NOAF after cardiac surgery. The primary outcome is the description of NOAF-maintaining structures within the atria. Key secondary outcomes include overall mortality, intensive care unit length of stay, hospital-ventilator-free days, and proportion of persistent NOAF. In NOAF patients, the non-invasive electrophysiological mapping will be conducted using a 252-electrode electrocardiogram vest. After mapping, a low-dose computed tomography scan of the chest will be performed to integrate the electrophysiological mapping results into a 3D picture of the heart. The study will include approximately 570 patients, of whom 30% (n = 170) are expected to develop NOAF. Sample size calculation revealed that 157 NOAF patients are necessary to assess the primary outcome. Patients will be tracked for a total of 5 years. Conclusions This is the largest prospective study to date describing the electrophysiological mechanisms of NOAF using non-invasive mapping.

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The impact of volume substitution on post‐operative atrial fibrillation

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 8 publications

References 28 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

The Prognostic Potential of Growth Differentiation Factor-15 on Bleeding Events and Patient Outcome after Cardiac Surgery—A Prospective Cohort Study

Non‐invasive evaluation of new‐onset atrial fibrillation after cardiac surgery: a protocol for the BigMap study

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