A comparison between oral antiarrhythmic drugs in the prevention of atrial fibrillation after cardiac surgery: the pilot study of prevention of postoperative atrial fibrillation (SPPAF), a randomized, placebo-controlled trial

Auer, Johann; Weber, Thomas; Baldassano, Robert N.; Puschmann, Rudolf; Hartl, P.; Ng, Choi-Keung; Schwarz, Christian; Lehner, Ernst; Strasser, Ulrike; Laßnig, Elisabeth; Lamm, Gudrun; Eber, Bernd

doi:10.1016/j.ahj.2003.10.041

Cited by 113 publications

(50 citation statements)

References 27 publications

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“…Atrial fibrosis may result in inhomogeneous structural fields which may increase the atrial refractoriness dispersion and alter the local conduction; ultimately leading to the electrophysiological instability in atrial tissue, and the occurrence of AF. Several studies have shown that some drugs such as beta-blockers or amiodarone can reduce the incidence of lone AF [19,20,21]. However, the histological investigation was not performed in these studies and the mechanism of drug action on fibrosis was not clear.…”

Section: Discussionmentioning

confidence: 87%

Histologic Assessment of Right Atrial Appendage Myocardium in Patients with Atrial Fibrillation after Coronary Artery Bypass Graft Surgery

Nakai

Chandy²,

Nakai

et al. 2006

Cardiology

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Atrial fibrillation (AF) is a common complication after coronary artery bypass graft (CABG) surgery. Despite the prevalence of AF occurring after cardiac surgery, its pathophysiology is incompletely understood. Our previous study demonstrated that age and left atrial enlargement were independent predictors of postoperative AF. Accordingly, the purpose of this study was to determine whether cellular changes such as fibrosis and/or hypertrophy occurred in the atrium in patients who subsequently developed postoperative AF. Right atrial appendage tissue was obtained during atriotomy in patients undergoing elective CABG surgery. Quantitative assessment of atrial fibrosis was performed with Sirius red stain, and atrial cell diameter was measured with the HE stain. Linear regression, t test, χ² test or Fisher exact test were used for statistical analysis. Sixty-one patients (mean age 71 ± 8 years) were studied. Increasing age was significantly associated with fibrosis (beta 0.3, 95% CI: 0.06–0.55, p = 0.017). The amount of right atrial fibrosis tended to correlate with the incidence of postoperative AF (p = 0.08). Cell diameter was not significantly different between patients with versus without postoperative AF (p = 0.85). These results suggest that the age-related atrial fibrosis rather than cellular hypertrophy may be important in the pathogenesis of AF after CABG surgery and should be further investigated.

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Section: Discussionmentioning

confidence: 87%

Histologic Assessment of Right Atrial Appendage Myocardium in Patients with Atrial Fibrillation after Coronary Artery Bypass Graft Surgery

Nakai

Chandy²,

Nakai

et al. 2006

Cardiology

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“…Consequently, this will increase the cost of surgery [28]. Prophylactic measures targeting patients at high risk of POAF, including pharmacologic strategies will significantly reduce the associated costs [29]. …”

Section: Discussionmentioning

confidence: 99%

Factors influencing postoperative atrial fibrillation in patients undergoing on-pump coronary artery bypass grafting, single center experience

Ismail

Elmahrouk

Hamouda

et al. 2017

J Cardiothorac Surg

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BackgroundThe reported incidence of AF after CABG surgery varies from 20 to 40%, with the arrhythmia usually occurring between second and fourth postoperative days. Postoperative AF after CABG was associated with greater in-hospital mortality and worse survival at long-term follow-up. Therefore, intensive attention has focused on the prevention of AF in high-risk patients. Many perioperative factors have been suggested to increase the incidence of postoperative AF after conventional CABG. In this study we are trying to examine some of these risk factors as predictors for Post-operative AF in our patients. In this study, our aim was to identify the perioperative predictors of AF in our patients who underwent Coronary Artery Bypass Grafting.MethodsOur Patients were divided into two groups; Group A included patients who did not develop PO AF (168 patients) and Group B patients who developed PO AF (84 patients). Perioperative Data, including gender, age, demographic variables and postoperative morbidity and mortality were extracted from the medical records.ResultsThis retrospective cohort study was conducted on 252 consecutive adult patients underwent CABG, in King Faisal Specialist Hospital and Research Center in Jeddah, Saudi Arabia. The mean age for patients with PO AF was 65 years (P = .0001). Eight-three patients (49.4%) were diabetics in group A and 56 patients (66.7%) in group B (P = .0001). Patients who developed POAF had a lower ejection fraction (44.8 ± 5.7%) (P = .0001), diastolic dysfunction (P = .0001), Larger Left atrial volume (P = .0001). Bleeding requiring re-opening for exploration and Postoperative shock were identified as significant predictors for POAF. Multivariate logistic regression (odds ratio, ±95% CI, P value) was performed to identify the effect of age, preoperative heart rate, ejection fraction, postoperative bleeding, Shock, ventilator time, Sensitivity was 89.5%, specificity was 94.6%, positive predictive value was 89.5%, and negative predictive value was 94.6%.ConclusionIn our study, advanced age, enlarged LA volume, low ejection fraction, combined surgeries and prolonged ventilation time were found to be predictors of atrial fibrillations after coronary artery bypass grafting.

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“…Sotalol has not been shown to be effective for conversion of AF to sinus rhythm. Sotalol has been used to reduce the risk of AF following CABG surgery [88]. However, the efficacy of sotalol for prophylaxis of AF after noncardiac thoracic surgery has not been investigated.…”

Section: Recommendations and Reasoningmentioning

confidence: 99%

2014 AATS guidelines for the prevention and management of perioperative atrial fibrillation and flutter for thoracic surgical procedures

Frendl

Sodickson

Chung

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

268

253

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A comparison between oral antiarrhythmic drugs in the prevention of atrial fibrillation after cardiac surgery: the pilot study of prevention of postoperative atrial fibrillation (SPPAF), a randomized, placebo-controlled trial

Cited by 113 publications

References 27 publications

Histologic Assessment of Right Atrial Appendage Myocardium in Patients with Atrial Fibrillation after Coronary Artery Bypass Graft Surgery

Histologic Assessment of Right Atrial Appendage Myocardium in Patients with Atrial Fibrillation after Coronary Artery Bypass Graft Surgery

Factors influencing postoperative atrial fibrillation in patients undergoing on-pump coronary artery bypass grafting, single center experience

2014 AATS guidelines for the prevention and management of perioperative atrial fibrillation and flutter for thoracic surgical procedures

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