Prevention of Atrial Fibrillation with Ultra-Low Dose Landiolol after Off-Pump Coronary Artery Bypass Grafting

Nagaoka, Eiki; Arai, Hirokuni; Tamura, Kiyoshi; Makita, Shuichi; Miyagi, Naoto

doi:10.5761/atcs.oa.12.02003

Cited by 27 publications

(25 citation statements)

References 10 publications

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“…The use of beta blockers, sotalol, amiodarone, or antioxidant vitamins lowers the risk of postoperative atrial fibrillation [79,80]. Meanwhile, the evidence is indefinite that the incidence of stroke can be reduced by any of these therapies.…”

Section: Preventive Therapies For Atrial Fibrillationmentioning

confidence: 99%

Stroke associated with coronary artery bypass grafting

Arai

2015

Gen Thorac Cardiovasc Surg

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While coronary artery bypass grafting (CABG) has been playing a significant role in the revascularization for ischemic heart disease, neurological complications associated with CABG have been a primary concern. Stroke, although the incidence is low, is one of the most devastating complication of CABG. Many studies have identified the risk factors for stroke with CABG, such as prior stroke, carotid artery stenosis, aortic atherosclerosis, atrial fibrillation and cardiopulmonary bypass. Various rational approaches focusing on individual risk factor have been proposed for the stroke. Prophylactic carotid revascularization is an important strategy, and the diagnosis of carotid stenosis has to be established correctly. Prevention of emboli from aortic plaque is also an essential issue. Intraoperative monitoring with transesophageal or epiaortic ultrasound is useful to identify mobile atheromatous plaques and to select appropriate aortic manipulations. Maintenance of cerebral blood flow and blood pressure during cardiopulmonary bypass might be critical issues. Besides, there are conflicting two opinions regarding off-pump CABG; one supports an efficiency for the prevention of stroke while the other advocates no effect. This discrepancy might be explained by the difference of the risk of stroke in the population of the individual study and by the variation of the percentage of aortic clamping or aortic anastomosis in each study. Pharmaceutical therapies such as statin, preventive medication for atrial fibrillation, or antiplatelet are promising methods. Although it is hard to decrease the incidence of the stroke with any single countermeasure, sustained effort should be continued to overcome the stroke associated with CABG.

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Section: Preventive Therapies For Atrial Fibrillationmentioning

confidence: 99%

Stroke associated with coronary artery bypass grafting

Arai

2015

Gen Thorac Cardiovasc Surg

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“…Various factors have been reported as causes of POAF, 31,32 and there are some reports that β-blockers are effective for preventing POAF after cardiovascular surgery. 33,34 Furthermore, the presence of high HbA1c levels (i.e., >7% or >8.6% 35) ) and/or hyperglycemia after cardiac surgery has been shown to be associated with POAF. 36) We observed no association between POAF and HbA1c values, possibly because HbA1c levels were relatively low (<7%) in our study population.…”

Section: Discussionmentioning

confidence: 99%

Glucose Variability Based on Continuous Glucose Monitoring Assessment Is Associated with Postoperative Complications after Cardiovascular Surgery

Sato

Hosojima

Ishikawa

et al. 2017

ATCS

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Purpose: This purpose of this prospective study was to use a continuous glucose monitoring (CGM) system to evaluate the suitability of our institution's glucose management protocol after cardiovascular surgery and to clarify the impact of glycemic variability on postoperative complications. Methods: In all, 76 patients who underwent elective cardiovascular surgery and were monitored perioperatively using a CGM system were evaluated. Postoperative glucose management consisted of continuous intravenous insulin infusion (CIII) in the intensive care unit, and subcutaneous insulin injections (SQII) after oral food intake started. CIII and subcutaneous injections were initiated when blood glucose level exceeded 150 mg/dL. CGM data were used to analyze perioperative glycemic variability and association with postoperative complications. Results: Target glucose levels (71-180 mg/dL) were achieved during 97.1 ± 5.5% and 86.4 ± 19.0% of the continuous insulin infusion and subcutaneous injection periods, respectively. Major postoperative complications were surgical site infections, found in 6.6% of total patients, and atrial fibrillation, found in 44% of patients with off-pump coronary artery bypass grafting. High glycemic variability during SQII was associated with increased risk for both complications. Conclusion: Data analysis revealed that our glucose management protocol during CIII was adequate. However, the management protocol during SQII required improvement.

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“…Although beta-blockers, amiodarone, anti-inflammatory therapy, and atrial pacing after surgery are effective for the prevention of PoAF 12,13 , it is still unclear why those therapies are effective in preventing PoAF. We hypothesized that the spatial and temporal dispersion of the atrial activation is associated with the initiation and sustenance of PoAF.…”

Section: Introductionmentioning

confidence: 99%

Temporal Dispersion of Atrial Activation Causes Postoperative Atrial Fibrillation

et al. 2020

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Background: Spatial dispersion of the atrial activation is one cause of post-operative atrial fibrillation (PoAF) after cardiac surgery. This study aimed to evaluate whether temporal dispersion of the atrial activation also causes PoAF after surgery in the clinical setting. Methods: Nineteen patients were enrolled to evaluate their postoperative atrial activation from atrial pacing wires on the right atrium by 24h Holter electrocardiography for 5 days after cardiac surgery. No patients had taken any antiarrhythmic drugs including beta-blockers. The cycle length of 15 continuous atrial beats was measured at 4 time points: (i) more than 12 hours before the PoAF as a control, (ii) just before the PoAF onset, (iii) during PoAF, and (iv) just before the termination of PoAF. The inhomogeneity of the atrial activation was quantified by the variation coefficient of the cycle length of 15 atrial beats during each phase. Results: The median inhomogeneity index of the atrial activation (first quartile, third quartile) was 0.102 (0.046, 0.136) in the control, 0.943 (0.582, 1.610) just before the PoAF onset (vs. control; p=0.009), 0.966 (0.631, 1.117) during PoAF, and 0.471 (0.138, 0.645) just before the termination of PoAF, respectively. Conclusions: Dispersion of the atrial activation significantly increased just before the PoAF onset. Temporal dispersion of the atrial activation is one of the precursory variations of PoAF.

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Prevention of Atrial Fibrillation with Ultra-Low Dose Landiolol after Off-Pump Coronary Artery Bypass Grafting

Cited by 27 publications

References 10 publications

Stroke associated with coronary artery bypass grafting

Stroke associated with coronary artery bypass grafting

Glucose Variability Based on Continuous Glucose Monitoring Assessment Is Associated with Postoperative Complications after Cardiovascular Surgery

Temporal Dispersion of Atrial Activation Causes Postoperative Atrial Fibrillation

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