Efeito da denervação cardíaca ventral na incidência de fibrilação atrial após revascularização cirúrgica do miocárdio

Breda, João Roberto; Breda, Ana Silvia Castaldi Ragognetti; Freitas, Andréa Cristina Oliveira; Meneghini, Adriano; Tavares, Carlos Mendes; Abreu, Luíz Carlos de; Murad, Neif; Pires, Ana Maria

doi:10.1590/s0102-76382008000200009

Cited by 6 publications

(1 citation statement)

References 18 publications

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“…A limited number of cases was studied. Nevetheless, the number of patients that underwent transection of ascending aorta in our study (67 cases; 132 controls) is not dissimilar from that of subjects submitted to anterior fat pad removal or ventral cardiac denervation in other studies (Davis et al [ 20 ] 73 cases, 58 controls; Cummings et al [ 22 ] 29 cases, 26 controls; Alex et al [ 28 ] 70 cases, 70 controls; AFIST-III stud [ 23 ] : 88 cases, 92 controls; Breda et al [ 26 ] 25 cases, 25 controls); only in the study by Melo et al. [ 25 ] , a greater number of cases was recruited (207 cases, 219 controls).…”

Section: Discussionsupporting

confidence: 46%

Abnormal heart rate variability and atrial fibrillation after aortic surgery

Compostella¹,

Russo²,

D’Onofrio³

et al. 2014

Revista Brasileira De Cirurgia Cardiovascular

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IntroductionComplete denervation of transplanted heart exerts protective effect against postoperative atrial fibrillation; various degrees of autonomic denervation appear also after transection of ascending aorta during surgery for aortic aneurysm.ObjectiveThis study aimed to evaluate if the level of cardiac denervation obtained by resection of ascending aorta could exert any effect on postoperative atrial fibrillation incidence.MethodsWe retrospectively analysed the clinical records of 67 patients submitted to graft replacement of ascending aorta (group A) and 132 with aortic valve replacement (group B); all episodes of postoperative atrial fibrillation occurred during the 1-month follow-up have been reported. Heart Rate Variability parameters were obtained from a 24-h Holter recording; clinical, echocardiographic and treatment data were also evaluated.ResultsOverall, 45% of patients (group A 43%, group B 46%) presented at least one episode of postoperative atrial fibrillation. Older age (but not gender, abnormal glucose tolerance, ejection fraction, left atrial diameter) was correlated with incidence of postoperative atrial fibrillation. Only among a subgroup of patients with aortic transection and signs of greater autonomic derangement (heart rate variability parameters below the median and mean heart rate over the 75th percentile), possibly indicating more profound autonomic denervation, a lower incidence of postoperative atrial fibrillation was observed (22% vs. 54%).ConclusionTransection of ascending aorta for repair of an aortic aneurysm did not confer any significant protective effect from postoperative atrial fibrillation in comparison to patients with intact ascending aorta. It could be speculated that a limited and heterogeneous cardiac denervation was produced by the intervention, creating an eletrophysiological substrate for the high incidence of postoperative atrial fibrillation observed.

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Section: Discussionsupporting

confidence: 46%

Abnormal heart rate variability and atrial fibrillation after aortic surgery

Compostella¹,

Russo²,

D’Onofrio³

et al. 2014

Revista Brasileira De Cirurgia Cardiovascular

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Concomitant atrial fibrillation surgery for people undergoing cardiac surgery

Huffman

Karmali

Berendsen

et al. 2016

Cochrane Database of Systematic Reviews

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Background People with atrial fibrillation (AF) often undergo cardiac surgery for other underlying reasons and are frequently offered concomitant AF surgery to reduce the frequency of short- and long-term AF and improve short- and long-term outcomes. Objectives To assess the effects of concomitant AF surgery among people with AF who are undergoing cardiac surgery on short-term and long-term (12 months or greater) health-related outcomes, health-related quality of life, and costs. Search methods Starting from the year when the first “maze” AF surgery was reported (1987), we searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library (March 2016), MEDLINE Ovid (March 2016), Embase Ovid (March 2016), Web of Science (March 2016), the Database of Abstracts of Reviews of Effects (DARE, April 2015), and Health Technology Assessment Database (HTA, March 2016). We searched trial registers in April 2016. We used no language restrictions. Selection criteria We included randomised controlled trials evaluating the effect of any concomitant AF surgery compared with no AF surgery among adults with preoperative AF, regardless of symptoms, who were undergoing cardiac surgery for another indication. Data collection and analysis Two review authors independently selected studies and extracted data. We evaluated the risk of bias using the Cochrane ‘Risk of bias’ tool. We included outcome data on all-cause and cardiovascular-specific mortality, freedom from atrial fibrillation, flutter, or tachycardia off antiarrhythmic medications, as measured by patient electrocardiographic monitoring greater than three months after the procedure, procedural safety, 30-day rehospitalisation, need for post-discharge direct current cardioversion, health-related quality of life, and direct costs. We calculated risk ratios (RR) for dichotomous data with 95% confidence intervals (CI) using a fixed-effect model when heterogeneity was low (I2 ≤ 50%) and random-effects model when heterogeneity was high (I2 > 50%). We evaluated the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework to create a ‘Summary of findings’ table. Main results We found 34 reports of 22 trials (1899 participants) with five additional ongoing studies and three studies awaiting classification. All included studies were assessed as having high risk of bias across at least one domain. The effect of concomitant AF surgery on all-cause mortality was uncertain when compared with no concomitant AF surgery (7.0% versus 6.6%, RR 1.14, 95% CI 0.81 to 1.59, I2 = 0%, 20 trials, 1829 participants, low-quality evidence), but the intervention increased freedom from atrial fibrillation, atrial flutter, or atrial tachycardia off antiarrhythmic medications > three months (51.0% versus 24.1%, RR 2.04, 95% CI 1.63 to 2.55, I2 = 0%, eight trials, 649 participants, moderate-quality evidence). The effect of concomitant AF surgery on 30-day mortality was uncertain (2.3% versus 3.1%, RR 1.25 95% CI 0.71...

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Prophylactic ventral cardiac denervation: Does it reduce incidence of atrial fibrillation after coronary artery bypass grafting?

Omran

Karimi

Ahmadi

et al. 2010

The Journal of Thoracic and Cardiovascular Surgery

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Objective: This study assessed the prophylactic effect of ventral cardiac denervation on reducing atrial fibrillation after coronary artery bypass grafting. Methods: This randomized prospective study recruited 220 adult patients (aged 42-79 years) who were scheduled to undergo coronary artery bypass grafting. Of these patients, 110 underwent ventral cardiac denervation in addition to coronary artery bypass grafting and 110 underwent only coronary artery bypass grafting. The demographic, intraoperative, and postoperative factors comprising atrial fibrillation were compared between the 2 groups. In addition, the predictive factors of atrial fibrillation in all 220 cases were assessed.

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Efeito da denervação cardíaca ventral na incidência de fibrilação atrial após revascularização cirúrgica do miocárdio

Cited by 6 publications

References 18 publications

Abnormal heart rate variability and atrial fibrillation after aortic surgery

Abnormal heart rate variability and atrial fibrillation after aortic surgery

Concomitant atrial fibrillation surgery for people undergoing cardiac surgery

Prophylactic ventral cardiac denervation: Does it reduce incidence of atrial fibrillation after coronary artery bypass grafting?

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