Atrial fibrillation after coronary artery bypass grafting: a comparison of cardioplegia versus intermittent aortic cross-clamping

Butler, John M.; Chong, J.; Rocker, Graeme; Pillai, Ramakrishna; Westaby, Stephen

doi:10.1016/1010-7940(93)90143-y

Cited by 31 publications

(13 citation statements)

References 5 publications

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“…The strongest predictor of POAF is advancing age. 1,2,4,6–9,15–18,44–48 Association with other risk factors shows a large degree of variability between different studies ( Table 2 ). For example, Zacharias et al .…”

Section: Epidemiologymentioning

confidence: 99%

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Post-operative atrial fibrillation: a maze of mechanisms

Maesen¹,

Nijs²,

Maessen³

et al. 2011

Europace

360

299

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Post-operative atrial fibrillation (POAF) is one of the most frequent complications of cardiac surgery and an important predictor of patient morbidity as well as of prolonged hospitalization. It significantly increases costs for hospitalization. Insights into the pathophysiological factors causing POAF have been provided by both experimental and clinical investigations and show that POAF is ‘multi-factorial’. Facilitating factors in the mechanism of the arrhythmia can be classified as acute factors caused by the surgical intervention and chronic factors related to structural heart disease and ageing of the heart. Furthermore, some proarrhythmic mechanisms specifically occur in the setting of POAF. For example, inflammation and beta-adrenergic activation have been shown to play a prominent role in POAF, while these mechanisms are less important in non-surgical AF. More recently, it has been shown that atrial fibrosis and the presence of an electrophysiological substrate capable of maintaining AF also promote the arrhythmia, indicating that POAF has some proarrhythmic mechanisms in common with other forms of AF. The clinical setting of POAF offers numerous opportunities to study its mechanisms. During cardiac surgery, biopsies can be taken and detailed electrophysiological measurements can be performed. Furthermore, the specific time course of POAF, with the delayed onset and the transient character of the arrhythmia, also provides important insight into its mechanisms.This review discusses the mechanistic interaction between predisposing factors and the electrophysiological mechanisms resulting in POAF and their therapeutic implications.

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Section: Epidemiologymentioning

confidence: 99%

“…1,2,4,6–9,15–18,44–48 Moreover, several arguments support that ageing enhances the development of a substrate capable of perpetuating AF. 149 As discussed above, ageing goes along with fibrosis 151,153,164 and is associated with slowing of conduction.…”

Section: Mechanisms Based On Pre-existing Factorsmentioning

confidence: 99%

Post-operative atrial fibrillation: a maze of mechanisms

Maesen¹,

Nijs²,

Maessen³

et al. 2011

Europace

360

299

View full text Add to dashboard Cite

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“…7,8 Occurrence of POAF after cardiac surgery is transient and self-limiting. Studies show that the peak incidence of AF following CABG is on the second postoperative day (POD) with more than one-third of such episodes occurring on that day.…”

mentioning

confidence: 99%

Postoperative atrial fibrillation: The role of the inflammatory response

Ishii

Schuessler

Gaynor

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

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Objective Abnormal atrial conduction has been shown to be a substrate for postoperative atrial fibrillation (POAF). This study aimed to determine the relationship between the location of the atrial reentry responsible for POAF, and degree of atrial inflammation. Methods Normal mongrel dogs (n = 18) were divided into 3 groups: anesthesia alone (anesthesia), lateral right atriotomy (atriotomy), and lateral right atriotomy with anti-inflammatory therapy (steroid). Conduction properties of the right and left atria (RA and LA) were examined 3 days postoperatively by mapping. Activation was observed during burst pacing–induced AF. The RA and LA myeloper-oxidase activity was measured to quantitate the degree of inflammation. Results Sustained AF (>2 minutes) was induced in 5 of 6 animals in the atriotomy group, but in none in the anesthesia or steroid groups. All sustained AF originated from around the RA incision. Three of these animals had an incisional reentrant tachycardia around the right atriotomy and 2 had a focal activation arising from the RA during AF. The LA activations in these animals were passive from the RA activation. The RA activation of the atriotomy group was more inhomogeneous than that of the anesthesia group (inhomogeneity index: 2.0 ± 0.2 vs 1.0 ± 0.1, P<.01). Steroid therapy significantly normalized the RA activation after the atriotomy (1.2 ± 0.1, P<.01). The inhomogeneity of the atrial conduction correlated with the myeloperoxidase activity (r = 0.774, P<.001). Conclusions Reentrant circuits responsible for POAF are dependent on the degree of inflammation and rotate around the atriotomy. Anti-inflammatory therapy decreased the risk of postoperative AF.

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“…A number of operative advances including the adoption of continuous cardioplegia [9], retrograde cardioplegia, warm cardioplegia and evolution of the cardioplegia cocktail, while improving myocardial protection, did not significantly alter the incidence of postoperative AF [8,[10][11][12]. The results of use of amiodarone with oral preoperative loading [13] and low dose IV postoperative infusion [14] are certainly encouraging.…”

Section: Introductionmentioning

confidence: 99%