Factors associated with postoperative atrial fibrillation and other adverse events after cardiac surgery

Akintoye, Emmanuel; Sellke, Frank W.; Marchioli, Roberto; Tavazzi, Luigi; Mozaffarian, Dariush

doi:10.1016/j.jtcvs.2017.07.063

Cited by 42 publications

(27 citation statements)

References 39 publications

(40 reference statements)

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“…Among the numerous consequences of AF are stroke, systemic embolization and heart failure [4]. The mechanistic cause of stand-alone AF is still unknown, although there are additional predisposing conditions such as the presence of mitral valve regurgitation [5] or the undertaking of cardiac surgery [6][7][8]. This uncertainty and variability has led to treatments that have a wide range of pharmacological actions [9], which are associated with a wide spectrum of cardiac side effects that include impaired left ventricular contractile function or serious arrhythmias such as atrioventricular block and QT prolongation (torsades de pointes) [9].…”

Section: Introductionmentioning

confidence: 99%

Role of SK channel activation in determining the action potential configuration in freshly isolated human atrial myocytes from the SKArF study

Shamsaldeen

Culliford

Clout

et al. 2019

Biochemical and Biophysical Research Communications

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Inhibition of SK channel function is being pursued in animal models as a possible therapeutic approach to treat atrial fibrillation (AF). However, the pharmacology of SK channels in human atria is unclear. SK channel function is inhibited by both apamin and UCL1684, with the former discriminating between SK channel subtypes. In this proof-of-principle study, the effects of apamin and UCL1684 on right atrial myocytes freshly isolated from patients in sinus rhythm undergoing elective cardiac surgery were investigated. Outward current evoked from voltage clamped human atrial myocytes was reduced by these two inhibitors of SK channel function. In contrast, membrane current underlying the atrial action potential was affected significantly only by UCL1684 and not by apamin. This pharmacology mirrors that observed in mouse atria, suggesting that mammalian atria possess two populations of SK channels, with only one population contributing to the action potential waveform. Immunovisualization of the subcellular localization of SK2 and SK3 subunits showed a high degree of colocalization, consistent with the formation of heteromeric SK2/SK3 channels. These data reveal that human atrial myocytes express two SK channel subtypes, one exhibiting an unusual pharmacology. These channels contribute to the atrial action potential waveform and might be a target for novel therapeutic approaches to treat supraventricular arrhythmic conditions such as atrial fibrillation.

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Section: Introductionmentioning

confidence: 99%

Role of SK channel activation in determining the action potential configuration in freshly isolated human atrial myocytes from the SKArF study

Shamsaldeen

Culliford

Clout

et al. 2019

Biochemical and Biophysical Research Communications

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“…PoAF occurs just 2-7 days after surgery and naturally resolves approximately 2 weeks after surgery. The incidence of PoAF is associated with the invasiveness of the surgical intervention 6 . Studies have proven that there are multiple factors inducing PoAF after cardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

Temporal Dispersion of Atrial Activation Causes Postoperative Atrial Fibrillation

et al. 2020

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Background: Spatial dispersion of the atrial activation is one cause of post-operative atrial fibrillation (PoAF) after cardiac surgery. This study aimed to evaluate whether temporal dispersion of the atrial activation also causes PoAF after surgery in the clinical setting. Methods: Nineteen patients were enrolled to evaluate their postoperative atrial activation from atrial pacing wires on the right atrium by 24h Holter electrocardiography for 5 days after cardiac surgery. No patients had taken any antiarrhythmic drugs including beta-blockers. The cycle length of 15 continuous atrial beats was measured at 4 time points: (i) more than 12 hours before the PoAF as a control, (ii) just before the PoAF onset, (iii) during PoAF, and (iv) just before the termination of PoAF. The inhomogeneity of the atrial activation was quantified by the variation coefficient of the cycle length of 15 atrial beats during each phase. Results: The median inhomogeneity index of the atrial activation (first quartile, third quartile) was 0.102 (0.046, 0.136) in the control, 0.943 (0.582, 1.610) just before the PoAF onset (vs. control; p=0.009), 0.966 (0.631, 1.117) during PoAF, and 0.471 (0.138, 0.645) just before the termination of PoAF, respectively. Conclusions: Dispersion of the atrial activation significantly increased just before the PoAF onset. Temporal dispersion of the atrial activation is one of the precursory variations of PoAF.

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“…7 Post-hoc analysis of the Evaluation of the Xience versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial 8 found that new-onset POAF incurred a 4-fold risk of stroke (adjusted hazard ratio [aHR], 4.19; 95% confidence interval [CI], 1.74-10.11). New-onset POAF was also associated with worse mortality at 30-days (odds ratio [OR], 5.0; 95% CI, 14-18) and 1-year (aHR, 2.2; 95% CI, 1.2-3.9) in an international multicenter study of 28 programs, 9 and with death at 3 years in the EXCEL trial (aHR, 3.02; 95% CI, 1.6-5.70).…”

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confidence: 99%

Treatment of postoperative atrial fibrillation: The long road ahead

Hui

Lee

2020

The Journal of Thoracic and Cardiovascular Surgery

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Factors associated with postoperative atrial fibrillation and other adverse events after cardiac surgery

Abstract: In this multicenter trial, we identified specific adverse outcomes that are associated with concomitant valvular and coronary artery bypass graft surgery, cardiopulmonary bypass, ventricular pacing, and occurrence of postoperative atrial fibrillation.

Cited by 42 publications

References 39 publications

Role of SK channel activation in determining the action potential configuration in freshly isolated human atrial myocytes from the SKArF study

Role of SK channel activation in determining the action potential configuration in freshly isolated human atrial myocytes from the SKArF study

Temporal Dispersion of Atrial Activation Causes Postoperative Atrial Fibrillation

Treatment of postoperative atrial fibrillation: The long road ahead

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