Determination of Histopathologic Risk Factors for Postoperative Atrial Fibrillation in Cardiac Surgery

Ak, Koray; Akgün, Serdar; Tecimer, Tülay; Isbir, C. Selim; Civelek, Ali; Tekeli, Atike; Arsan, Sinan; Çobanoğlu, Adnan

doi:10.1016/j.athoracsur.2004.12.029

Cited by 33 publications

(37 citation statements)

References 26 publications

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“…However, it is still difficult to explain why some patients develop AF whereas others with the same risk factors do not. 18 The answer seems to lie in the anatomy, as shown in Figures 1 and 2. Coronary bypass surgery requires removal from the ascending aorta of adventitial tissue and the aortic fat pad, which contains the SA node lymphatic collector, an anatomical detail not widely acknowledged.…”

Section: Atrial Fibrillationmentioning

confidence: 93%

Aortic fat pad and atrial fibrillation: cardiac lymphatics revisited

Lupinski

2009

ANZ Journal of Surgery

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The lymphatics of the heart have not generated any broad or sustained interest among clinicians. Few publications on cardiac lymphatics are available, the anatomy is not routinely known and the true role of cardiac lymphatics remains doubtful. One important anatomical concept needing clarification is that of the lymphatic drainage of conduction tissue. The sinoatrial node lymphatic collector and right principal lymphatic trunk are both incorporated into the aortic fat pad of the ascending aorta and are the most frequently damaged lymphatic vessels during cardiac surgery. Thus, preservation of the aortic fat pad and its lymphatic collectors should reduce the incidence of new atrial fibrillation observed in patients after cardiac surgery. This review assesses current knowledge of cardiac lymphatics and shows their possible role in triggering arrhythmias in the postoperative period.

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Section: Atrial Fibrillationmentioning

confidence: 93%

Aortic fat pad and atrial fibrillation: cardiac lymphatics revisited

Lupinski

2009

ANZ Journal of Surgery

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“…A later study conducted by Ak et al confirmed these results by detection of degree of myolysis as one of the predictors for the incidence of AF after the elective on-pump CABG in 100 patients [79]. Univariate analysis showed that not only myolysis but a greater apoptosis of myocytes as well are predictive histological factors for the occurrence of postoperative AF ( Table 3).…”

Section: Histopathological Data As a Substrate For The Development Ofmentioning

confidence: 57%

“…Univariate analysis showed that not only myolysis but a greater apoptosis of myocytes as well are predictive histological factors for the occurrence of postoperative AF ( Table 3). Older age did not correlate to the risk of postoperative AF in this study [79].…”

Section: Histopathological Data As a Substrate For The Development Ofmentioning

confidence: 89%

Pathophysiological Insights into Atrial Fibrillation Following Cardiac Surgery: Implications for Current Pharmaceutical Design

Kairevičiūtė

Aidietis²,

Lip³

2009

CPD

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Atrial fibrillation (AF) following cardiac surgery is a common complication, which increases incidence of other complications, hospital and healthcare costs. The reported rate of the occurrence of postoperative AF varies with different studies, depending on population profile, type of surgery, arrhythmia definition and detection methods, design of study. Nonetheless, the precise mechanisms of AF related to cardiac surgery are poorly understood. A diverse variety of reasons have been proposed for the pathogenesis of this common cardiac arrhythmia. The aim of this review article is to provide an overview of pathophysiological processes that lead to the development of AF post-cardiac surgery. These processes are closely inter-related but the most important ones that have bearing on drug design include the RAAS, ion channels, connexins, fibrosis and extracellular matrix turnover, inflammation and oxidative stress. The autonomic nervous system and structural remodeling all influence all these pathophysiological processes, which should not be viewed in isolation. Understanding such processes would have major implications for the approach to current pharmaceutical design, to improve our approach to drug management strategies.

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“…55 Ultrastructural changes in the atria of patients who developed AF after cardiac surgery have been documented. 24,25,56 In patients without a history of AF, the severity of preoperative myolysis correlated well with the occurrence of PoAF. 24 A relationship of the incidence of PoAF and the amount of fibrosis in the right 35 and left 52 atrial appendages of patients undergoing cardiac surgery highlights the pathogenic role of atrial fibrosis in arrhythmogenesis (Figure 2).…”

Section: Role Of Abnormal Atrial Substrate In Poafmentioning

confidence: 88%

Circulating Biomarkers Predictive of Postoperative Atrial Fibrillation

Turagam

Mirza

Werner

et al. 2016

Cardiology in Review

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Postoperative atrial fibrillation (PoAF), a common complication of cardiac surgery, contributes significantly to morbidity, mortality, and increasing health care costs. Despite advances in surgical and medical management, the overall incidence of PoAF has not changed significantly, partly due to the limited understanding of mechanisms underlying acute surgery-related factors, such as myocardial injury, inflammation, sympathetic activation, and oxidative stress, which play an important role in the initiation of PoAF, while a preexisting atrial substrate appears to be more important in the maintenance of this dysrhythmia. Thus, in a majority of patients, PoAF becomes a manifestation of an underlying arrhythmogenic substrate that is unmasked following acute surgical stress. As such, the ability to identify which patients have this proarrhythmic substrate and are, therefore, at high risk for developing AF postoperatively, is important for the improved selection for prophylactic interventions, closer monitoring for complications, and establishing the probability of AF in the long term. This review highlights the role of the underlying substrate in promoting PoAF, proposed mechanisms, and the potential role of serum biomarkers to identify patients at risk for PoAF.

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Determination of Histopathologic Risk Factors for Postoperative Atrial Fibrillation in Cardiac Surgery

Cited by 33 publications

References 26 publications

Aortic fat pad and atrial fibrillation: cardiac lymphatics revisited

Aortic fat pad and atrial fibrillation: cardiac lymphatics revisited

Pathophysiological Insights into Atrial Fibrillation Following Cardiac Surgery: Implications for Current Pharmaceutical Design

Circulating Biomarkers Predictive of Postoperative Atrial Fibrillation

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