Novel insights in pathophysiology of postoperative atrial fibrillation

Abstract

Objectives: Atrial extrasystoles are usually benign; however, they can also trigger atrial fibrillation. It is most likely that if atrial extrasystoles provoke a larger amount of conduction disorders and a greater degree of endo-epicardial asynchrony, the risk of postoperative atrial fibrillation increases. To test this hypothesis, we investigated the effect of programmed atrial extrasystoles on endo-epicardial conduction and postoperative atrial fibrillation.

Commentary: New sight, lost sight, insight, and novel sight

“…Kharbanda and colleagues 1 are certainly correct that higher levels of endoepicardial conduction asynchrony are consistent with the electroanatomic heterogeneity fundamental to reentrant dysrhythmias. Indeed, cardiomyocyte and cultural disparities are challenging and perhaps inevitable.…”

Characterization of pre-existing arrhythmogenic substrate associated with de novo early and late postoperative atrial fibrillation

“…[8][9][10] In the vast majority of patients, episodes [23,[25][26][27] These atrial extrasystoles are associated with enhanced conduction disorders and epi-endocardial asynchrony. [28] PoAF then occurs when these transient, postoperative triggers act on vulnerable, remodeled, atrial tissue. [9,10] This substrate can either be produced by surgery-induced or postoperative remodeling processes.…”

Commentary: Okay, now what?

“…In this issue of JTCVS Open , Kharbanda and colleagues 2 from the Erasmus Medical Center in Rotterdam present their work on endoepicardial asynchrony and the impact of atrial extrasystoles on POAF. This work involved complex mapping of the endocardial and epicardial surfaces of the right atrium during cardiac surgery in adults using 256 electrodes.…”