Inflammation in new‐onset atrial fibrillation after cardiac surgery: a systematic review

Abstract

Background Postoperative new-onset atrial fibrillation (PNAF) is the most common complication following cardiac surgery. The pathogenesis of PNAF is multifactorial. The concept of the postoperative inflammatory response, as a potential underlying mechanism has been extensively studied. This review aims to provide a comprehensive summary of literature relevant to the association between the inflammatory response following cardiac surgery and PNAF.

Vitamin C for the Prevention of Postoperative Atrial Fibrillation after Cardiac Surgery: A Meta-Analysis

“…32 An increased white blood cell count correlates with postoperative AF, although the association is less straightforward in the case of other inflammatory biomarkers. 55 Peroxidase levels seem to be the most reliable prognostic marker, among serum biomarkers for oxidative stress, for new onset AF. 56 In postoperative AF, there is an increased peroxynitrite concentration, a free radical formed from hydrogen peroxide and nitrite, which is a target for vitC.…”

“…53,54 Supporting the inflammation hypothesis is the correlation between the levels of markers of inflammation, including fibrinogen, white blood cell count, hsCRP, and IL-6, and the development of postoperative AF. 55 Postoperative inflammation markers peak around the 3 rd postoperative day, which coincides with the bulk of postoperative AF: 2/3 of the cases of AF occur before the 4 th postoperative day. 32 An increased white blood cell count correlates with postoperative AF, although the association is less straightforward in the case of other inflammatory biomarkers.…”

Early and Late Atrial Arrhythmias After Lung Transplantation ― Incidence, Predictive Factors and Impact on Mortality ―

“…2,15,16 Inflammation has been associated with AF 17 and its implications following thoracic surgery has been extensively studied. 18 Pericardial inflammation after surgery, variation in left and right atrial pressures, changes in oxygenation, pain and stress may influence atrial conduction and refractory periods, predisposing to AF. The factors related to thoracic surgery may decrease during the recovery phase, usually during the first month, and may relate to atrial electrical reverse remodeling.…”

Intraoperative Magnesium Administration Does Not Reduce Postoperative Atrial Fibrillation After Cardiac Surgery

“…Although many pharmacological approaches to preventing atrial fibrillation after cardiac surgery have been investigated, 40,41 the studies evaluating Mg have yielded mixed results. We found that, despite significantly higher Mg levels in the intraoperative and immediate postoperative period, high-dose intraoperative Mg therapy did not decrease the incidence of new-onset POAF.…”