Background-Postoperative atrial fibrillation (POAF) is a highly prevalent complication after cardiac surgery with substantial effects on outcomes. Previous studies have reported that obesity is a risk factor for POAF after cardiac surgery. However, it is unknown whether the metabolic syndrome (MS) also increases the risk of postoperative atrial fibrillation. Methods and Results-We retrospectively analyzed the association between obesity and MS and the incidence of new-onset POAF in a total of 5085 patients who underwent isolated coronary artery bypass grafting surgery with no concomitant valvular surgery. Of these patients, 1468 (29%) were obese (body mass index Ն30 kg/m 2 ) and 2320 (46%) had a MS as defined by the NCEP-ATPIII. POAF occurred in 1374 (27%) of the patients. Obesity was associated (PϽ0.001) with increased incidence of POAF in the whole cohort as well as in patients Ͼ50 years old but not in patients Յ50 years old. In these patients, MS was the only metabolic factor to be significantly associated with higher incidence of POAF (12% versus 6%, Pϭ0.01). In Ͼ50-year-old patients, mild (30 Յ body mass index Ͻ35 kg/m 2 ) and moderate-severe (body mass index Ն35 kg/m 2 ) obesity were independently associated with a 1.4-fold (95% CI: 1.10 to 1.71; Pϭ0.004) and 2.3-fold (95% CI: 1.71 to 3.13; PϽ0.0001) increase in the risk of POAF, respectively. In Յ50-year-old patients, MS (relative risk [RR]: 2.36; 95% CI: 1.10 to 5.12; Pϭ0.02) but not obesity was independently associated with POAF. Conclusion-This study demonstrates that obesity is a powerful risk factor for the occurrence of POAF after isolated coronary artery bypass grafting surgery in patients older than 50 years. However, in the younger population, this association is not observed and MS is the only metabolic risk factor to be independently associated with POAF.
Block of I(Kr) gives an explanation to lengthening of cardiac repolarization observed in isolated guinea pig hearts. Potent block of I(Kr) is also likely to underlie prolongation of the QT interval observed in patients receiving clinically recommended doses of cisapride as well as severe cardiac toxicity (torsades de pointes) observed in patients with increased plasma concentrations of the drug.
Domperidone possesses cardiac electrophysiological effects similar to those of cisapride and class III antiarrhythmic drugs. These effects are observed at clinically relevant concentrations of the drug. Therefore, domperidone should not be considered a no-risk alternative to cisapride, a drug that was recently withdrawn from the US market.
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