The Role of Inflammation in Atrial Fibrillation following Open Heart Surgery

Abstract

This study investigated the role of systemic inflammation in the development of atrial fibrillation (AF) after coronary artery bypass grafting (CABG). CABG was performed using cardiopulmonary bypass in 77 patients. Pre-operative AF was present in six patients (7.8%) and postoperative AF developed in 13 (18.3%) of the 71 patients with pre-operative sinus rhythm. Post-operative mediastinal drainage was significantly increased in patients with post-operative AF compared with those with sinus rhythm. Plasma E-selectin, P-selectin and vascular cell adhesion molecule levels were not significantly different between patients with pre- and post-operative sinus rhythm, those with pre-operative sinus rhythm and post-operative AF, and those with pre- and post-operative AF. There were significant differences between pre- and post-operative C-reactive protein, interleukin (IL)-6 and IL-10 levels within all three groups, but no differences in these parameters between the groups. Thus, in all groups there were significant alterations in mediators indicative of systemic inflammation following CABG, but comparisons between the groups revealed no differences predictive of AF.

Systemic vascular cell adhesion molecule-1 predicts the occurrence of post-operative atrial fibrillation

“…Inflammation and oxidative stress may play a key role in the establishment of an appropriate substrate for the arrhythmia [8,26,27] rendering the patients susceptible to the inflammatory injury associated with cardiopulmonary bypass [28,29]. Previous reports have described that increased levels of pro inflammatory cytokines [27,30], white blood cell count [31][32][33] and complement-CRP complexes [34] may predict POAF development.…”

“…Although it has been extensively investigated, the precise etiology of POAF remains elusive [8]. Inflammation and oxidative stress may play a key role in the establishment of an appropriate substrate for the arrhythmia [8,26,27] rendering the patients susceptible to the inflammatory injury associated with cardiopulmonary bypass [28,29].…”

“…Even when it is usually considered benign, POAF accounts for increased short and long-term mortality [3][4][5], postoperative hemodynamic instability [6], increased stroke risk [7] and increased health costs [8]. It has been demonstrated that inflammation and oxidative stress are related with the occurrence of atrial fibrillation [9][10][11].…”

Association of Preoperative Platelet-to-Lymphocyte Ratio with Atrial Fibrillation after Coronary Artery Bypass Graft Surgery

“…In addition to the normal ageing process, cardiac surgery itself induces a systemic inflammatory response [17] . A previous study reported higher serum resistin levels both in the pre-and postoperative phases along with other proinflammatory markers (IL-6, IL-10, and CRP) [18] . These studies support the finding that inflammatory pathways, from either the advancing age or surgery or even both, could be a potential reason for the development of postoperative AF.…”

Leukocyte-Aprotinin Atrial Fibrillation Study (LAFFS): Impact of Aprotinin and Leukofiltration on Atrial Fibrillation, Renal Insufficiency and Encephalopathy Post-Cardiopulmonary Bypass

“…4 Another approach is the use of leukocyte filters, 5 as there seems to be a connection between atrial fibrillation and inflammation. 6,7 Indeed, systemic inflammation can elicit atrial fibrillation by activating the complement system and stimulating release of activated cytokines.…”