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Yang Z, Tiemuerniyazi X, Huang S, Song Y, Xu F, Feng W. Partial CArdiac Denervation to Prevent Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting (pCAD-POAF): Study Protocol for a Randomized Controlled Trial. Am J Cardiol 2024; 221:120-125. [PMID: 38649126 DOI: 10.1016/j.amjcard.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/25/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
Postoperative atrial fibrillation (POAF) is commonly seen in patients who underwent coronary artery bypass grafting (CABG), increasing the risk of morbidity, mortality, and hospital expenses. This study aimed to evaluate the effect of partial cardiac denervation, which is achieved by cutting off the ligament of Marshall and resecting the fat pad along the Waterston groove, on the prevention of POAF after CABG. Patients planned for CABG at our center were screened for eligibility in this study. A total of 430 patients were randomized into the intervention (partial cardiac denervation) group and control group. Intraoperative high-frequency electrical stimulation and further histologic analysis were performed in a certain number of patients to confirm the existence of ganglia. All patients were continuously monitored for the incidence of POAF through an electrophysiologic device until the sixth day postoperatively, and required to complete a 30-day follow-up (12-lead electrocardiogram and echocardiogram assessment) after discharge. The primary end point is the incidence of POAF, whereas the secondary end points are the cost-effectiveness and safety outcomes. In conclusion, this trial will evaluate whether partial cardiac denervation through cutting off the ligament of Marshall and resecting the fat pad along the Waterston groove can reduce the incidence of POAF after CABG. If this procedure is revealed to be effective and safe, it may provide a potential therapeutic approach to prevent POAF in this group of patients.
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Affiliation(s)
- Ziang Yang
- Department of Cardiovascular Surgery, Fuwai Hospital; National Center for Cardiovascular Diseases; National Clinical Research Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences; and Peking Union Medical College, Beijing, China
| | - Xieraili Tiemuerniyazi
- Department of Cardiovascular Surgery, Fuwai Hospital; National Center for Cardiovascular Diseases; National Clinical Research Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences; and Peking Union Medical College, Beijing, China
| | - Shengkang Huang
- Department of Cardiovascular Surgery, Fuwai Hospital; National Center for Cardiovascular Diseases; National Clinical Research Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences; and Peking Union Medical College, Beijing, China
| | - Yangwu Song
- Department of Cardiovascular Surgery, Fuwai Hospital; National Center for Cardiovascular Diseases; National Clinical Research Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences; and Peking Union Medical College, Beijing, China
| | - Fei Xu
- Department of Cardiovascular Surgery, Fuwai Hospital; National Center for Cardiovascular Diseases; National Clinical Research Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences; and Peking Union Medical College, Beijing, China.
| | - Wei Feng
- Department of Cardiovascular Surgery, Fuwai Hospital; National Center for Cardiovascular Diseases; National Clinical Research Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences; and Peking Union Medical College, Beijing, China.
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Oh S. Neuromodulation for Atrial Fibrillation Control. Korean Circ J 2024; 54:223-232. [PMID: 38654454 PMCID: PMC11109834 DOI: 10.4070/kcj.2024.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/13/2024] [Indexed: 04/26/2024] Open
Abstract
Trigger and functional substrate are related to the tone of autonomic nervous system, and the role of the autonomic nerve is more significant in paroxysmal atrial fibrillation (AF) compared to non-paroxysmal AF. We have several options for neuromodulation to help to manage patients with AF. Neuromodulation targets can be divided into efferent and afferent pathways. On the efferent side, block would be an intuitive approach. However, permanent block is hard to achieve due to completeness of the procedure and reinnervation issues. Temporary block such as botulinum toxin injection into ganglionated plexi would be a possible option for post-cardiac surgery AF. Low-level subthreshold stimulation could also prevent AF, but the invasiveness of the procedure is the barrier for the general use. On the afferent side, block is also an option. Various renal denervation approaches are currently under investigation. Auditory vagus nerve stimulation is one of the representative low-level afferent stimulation methods. This technique is noninvasive and easy to apply, so it has the potential to be widely utilized if its efficacy is confirmed.
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Affiliation(s)
- Seil Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
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Sathnur N, Li JM, Krishnappa D, G Benditt D. Impact of Denervation by Heart Transplantation on Post-operative Atrial Fibrillation Susceptibility. J Atr Fibrillation 2020; 13:2397. [PMID: 33024498 DOI: 10.4022/jafib.2397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 02/13/2020] [Accepted: 03/17/2020] [Indexed: 11/10/2022]
Abstract
Atrial fibrillation is common following cardiac and non-cardiac thoracic surgery and is associated with poorer outcomes, including: increased risk of stroke, hemodynamic instability, prolonged hospital stay, and increased mortality. Current understanding suggests that post-op atrial fibrillation results from the interplay of local and systemic operative inflammation, increased sympathetic activity, perhaps the release of free radical species in the perioperative period, and the patient's underlying cardiac substrate. Cardiac denervation following orthotopic heart transplant (OHT) using modern bicaval techniques presents a unique opportunity to study the relative contribution of the autonomic nervous system to post-op atrial fibrillation susceptibility. Observational studies show a reduced incidence of post-operative atrial fibrillation following orthotopic heart transplant compared to other cardiac and thoracic surgeries. Moreover, comparison of atrial fibrillation rates with double lung transplant recipients suggests that cardiac denervation has a contribution apart from surgical pulmonary vein isolation alone. This report reviews current concepts of the mechanisms of post-op atrial fibrillation with a focus on the role of the autonomic nervous system, the autonomic regulation of the native heart, and evidence regarding the impact of cardiac denervation following OHT.
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Affiliation(s)
- Neeraj Sathnur
- Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine
| | - Jian-Ming Li
- Division of Cardiology, VA Medical Center, University of Minnesota, Minneapolis, Minnesota
| | - Darshan Krishnappa
- Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine
| | - David G Benditt
- Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine
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Postoperative Atrial Fibrillation Following Cardiac Surgery: From Pathogenesis to Potential Therapies. Am J Cardiovasc Drugs 2020; 20:19-49. [PMID: 31502217 DOI: 10.1007/s40256-019-00365-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Postoperative atrial fibrillation (POAF) is a major complication after cardiac surgery which can lead to high rates of morbidity and mortality, an enhanced length of hospital stay, and an increased cost of care. POAF is postulated to be a multifactorial phenomenon; however, some major pathogeneses have been proposed, including inflammatory pathways, oxidative stress, and autonomic dysfunction. Genetic studies also showed that inflammatory pathways, beta-1 adrenoreceptor variants, G protein-coupled receptor kinase 5 gene variants, and non-coding single-nucleotide polymorphisms in the 4q25 chromosomal locus are involved in this phenomenon. Moreover, several predisposing factors lead to the development of POAF, consisting of pre-, intra-, and postoperative contributors. The main predisposing factors comprise age, prior history of major cardiovascular risk factors, and ischemia-reperfusion injury during surgery. The management of POAF is based on the usual therapies used for non-surgical AF, including medications for either rate control or rhythm control in hemodynamically unstable patients. The perioperative administration of β-blockers and some antiarrhythmic agents has been recommended in major international guidelines. In addition, upstream therapies consisting of colchicine, magnesium, statins, and antioxidants have attenuated the incidence of POAF; however, some uncomfortable side effects developed in large randomized trials. The use of anticoagulation has also resulted in less mortality in patients with POAF at higher risk of thromboembolic events. Despite these recommendations, the actual regimen for the prevention of POAF remains controversial. In this review, we highlight the pathogenesis, predisposing factors, and potential therapeutic options for the management of patients at risk for or with POAF following cardiac surgery.
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Simple Amiodarone Protocol Reduces Postoperative Atrial Fibrillation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 1:268-71. [DOI: 10.1097/01.imi.0000234910.50576.57] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Incorporating amiodarone into an existing postoperative atrial fibrillation (AF) prevention pathway may reduce postoperative AF and length of stay (LOS). Methods From July 2002 through December 2002, 476 consecutive cardiac surgical patients were managed with an AF prevention protocol using aggressive potassium replacement, intraoperative/ postoperative magnesium supplementation, and postoperative resumption of β-blockers. From January 2003 through June 2003, 592 additional patients were subjected to the same protocol except amiodarone was initiated intraoperatively (150 mg intravenously) and continued postoperatively until discharge (200 mg orally three times daily). Incidence of AF, postoperative LOS, and AF risk factors were collected prospectively and compared using regression models with propensity scores to adjust for dissimilarities between groups. Results Incorporating amiodarone into an existing AF protocol resulted in a 45% reduction in postoperative AF (29% [136/476] versus 16% [94/592], P < 0.0001). After adjustment for covariates and propensity score, the relative risk reduction with amiodarone in this protocol remained significant (P = 0.001, RR 0.65, 95% CI 0.5–0.8). Multivariate risks for postoperative AF included no amiodarone (P = 0.0001), age (P < 0.0001), ejection fraction <40% (P = 0.0005), ventilator support >24 hours (P = 0.002), no postoperative β-blocker (P = 0.002), and mitral valve procedure (P = 0.03). When postoperative AF did occur, risk adjusted LOS was less in patients on the amiodarone protocol (mean 9.4 days versus 13.1 days, P = 0.06). Readmission after discharge for any reason (10% [49/476] versus 8% [45/592], P = 0.1) or for AF (1.1% [5/476] versus 0.7% [4/592], P = 0.5) was similar between groups. Conclusion Amiodarone initiated intraoperatively followed by oral dosing significantly reduces postoperative AF and tends to reduce LOS if AF occurs.
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Styczkiewicz K, Spadacini G, Tritto M, Perego GB, Facchini M, Bilo G, Kawecka-Jaszcz K, Czarnecka D, Malfatto G, Parati G. Cardiac autonomic regulation in patients undergoing pulmonary vein isolation for atrial fibrillation. J Cardiovasc Med (Hagerstown) 2019; 20:297-305. [PMID: 30921268 DOI: 10.2459/jcm.0000000000000791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Ablation procedures for the treatment of atrial fibrillation lead to changes in autonomic heart control; however, there are insufficient data on the possible association of these changes with atrial fibrillation recurrence. The study aim was to assess the effects of pulmonary vein isolation (PVI) on cardiac autonomic modulation and atrial fibrillation recurrence. METHODS We screened 52 patients with atrial fibrillation referred for PVI, of whom 20 patients met inclusion and exclusion criteria, and were enrolled in the study and followed over 6 months. Beat-to-beat blood pressure monitoring was performed 1-2 days before PVI, 1 and 6 months after PVI. We estimated pulse interval variability and spontaneous baroreflex sensitivity (BRS) both in the time and frequency domains, and performed the Valsalva manoeuvre assessing the Valsalva ratio. RESULTS During 6 months after PVI, atrial fibrillation recurrence was observed in six patients. One month after PVI, pulse interval variability and BRS (sequence method) significantly decreased in all patients, returning to preintervention values by 6 months. Patients without atrial fibrillation recurrence at 1 month showed a transient reduction in pulse interval variability (frequency domain) and in BRS (both methods) in contrast to those with atrial fibrillation recurrence. A significant decrease in the Valsalva ratio observed at 1 month was maintained at 6 months after PVI in both groups. CONCLUSION Successful PVI may lead to transient autonomic alterations reflected by a reduction in pulse interval variability and BRS, with more prolonged changes in the Valsalva ratio. The efficacy of PVI in preventing atrial fibrillation recurrence seems to be related to transient parasympathetic atrial denervation.
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Affiliation(s)
- Katarzyna Styczkiewicz
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy.,The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Giammario Spadacini
- Electrophysiology and Cardiac Pacing Operative Unit, Humanitas Mater Domini Hospital, Castellanza (VA)
| | - Massimo Tritto
- Electrophysiology and Cardiac Pacing Operative Unit, Humanitas Mater Domini Hospital, Castellanza (VA)
| | - Giovanni B Perego
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy
| | - Mario Facchini
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy
| | - Grzegorz Bilo
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy.,Department of Medicine and Surgery, University of Milano- Bicocca, Milan, Italy
| | - Kalina Kawecka-Jaszcz
- The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Danuta Czarnecka
- The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Gabriella Malfatto
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy
| | - Gianfranco Parati
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy.,Department of Medicine and Surgery, University of Milano- Bicocca, Milan, Italy
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Carnagarin R, Kiuchi MG, Ho JK, Matthews VB, Schlaich MP. Sympathetic Nervous System Activation and Its Modulation: Role in Atrial Fibrillation. Front Neurosci 2019; 12:1058. [PMID: 30728760 PMCID: PMC6351490 DOI: 10.3389/fnins.2018.01058] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 12/31/2018] [Indexed: 12/17/2022] Open
Abstract
The autonomic nervous system (ANS) has a significant influence on the structural integrity and electrical conductivity of the atria. Aberrant activation of the sympathetic nervous system can induce heterogeneous changes with arrhythmogenic potential which can result in atrial tachycardia, atrial tachyarrhythmias and atrial fibrillation (AF). Methods to modulate autonomic activity primarily through reduction of sympathetic outflow reduce the incidence of spontaneous or induced atrial arrhythmias in animal models and humans, suggestive of the potential application of such strategies in the management of AF. In this review we focus on the relationship between the ANS, sympathetic overdrive and the pathophysiology of AF, and the potential of sympathetic neuromodulation in the management of AF. We conclude that sympathetic activity plays an important role in the initiation and maintenance of AF, and modulating ANS function is an important therapeutic approach to improve the management of AF in selected categories of patients. Potential therapeutic applications include pharmacological inhibition with central and peripheral sympatholytic agents and various device based approaches. While the role of the sympathetic nervous system has long been recognized, new developments in science and technology in this field promise exciting prospects for the future.
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Affiliation(s)
- Revathy Carnagarin
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Marcio G Kiuchi
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Jan K Ho
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Vance B Matthews
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia, Perth, WA, Australia.,Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, WA, Australia.,Neurovascular Hypertension and Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
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Ilkan Z, Akar FG. The Mitochondrial Translocator Protein and the Emerging Link Between Oxidative Stress and Arrhythmias in the Diabetic Heart. Front Physiol 2018; 9:1518. [PMID: 30416455 PMCID: PMC6212558 DOI: 10.3389/fphys.2018.01518] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 10/09/2018] [Indexed: 02/06/2023] Open
Abstract
The mitochondrial translocator protein (TSPO) is a key outer mitochondrial membrane protein that regulates the activity of energy-dissipating mitochondrial channels in response to oxidative stress. In this article, we provide an overview of the role of TSPO in the systematic amplification of reactive oxygen species (ROS) through an autocatalytic process known as ROS-induced ROS-release (RIRR). We describe how this TSPO-driven process destabilizes the mitochondrial membrane potential leading to electrical instability at the cellular and whole heart levels. Finally, we provide our perspective on the role of TSPO in the pathophysiology of diabetes, in general and diabetes-related arrhythmias, in particular.
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Affiliation(s)
- Zeki Ilkan
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Fadi G Akar
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Compostella L, Russo N, D'Onofrio A, Setzu T, Compostella C, Bottio T, Gerosa G, Bellotto F. Abnormal heart rate variability and atrial fibrillation after aortic surgery. Braz J Cardiovasc Surg 2015; 30:55-62. [PMID: 25859868 PMCID: PMC4389516 DOI: 10.5935/1678-9741.20140100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 08/04/2014] [Indexed: 11/20/2022] Open
Abstract
Introduction Complete 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. Objective This 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. Methods We 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. Results Overall, 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%). Conclusion Transection 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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Affiliation(s)
| | | | - Augusto D'Onofrio
- Dpt Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | | | | | - Tomaso Bottio
- Dpt Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Gino Gerosa
- Dpt Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
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Mapping and ablation of autonomic ganglia in prevention of postoperative atrial fibrillation in coronary surgery: MAAPPAFS atrial fibrillation randomized controlled pilot study. Can J Cardiol 2014; 30:1202-7. [PMID: 25262862 DOI: 10.1016/j.cjca.2014.04.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 04/07/2014] [Accepted: 04/07/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Postoperative atrial fibrillation (POAF) remains common after coronary artery bypass grafting (CABG). Limited efforts to intervene on cardiac autonomic ganglionic plexi (AGP) during surgery show mixed results. In this pilot study, we evaluated the safety and feasibility of map-guided ablation of AGPs during isolated CABG in the prevention of POAF. METHODS In this pilot study, patients undergoing isolated CABG were randomized into an intervention group (mapping and ablation of AGP [AGP+] group), and a control group (no mapping and ablation [AGP-] group). Using high-frequency stimulation, active AGPs were identified and ablated intraoperatively using radiofrequency. Continuous rhythm monitoring, serum electrolytes, postoperative medications, and postoperative complications were recorded until discharge. RESULTS Randomization of 47 patients (24 AGP+ and 23 AGP-) resulted in similar baseline characteristics, past medical history, and preoperative medication use. The intervention added a median of 14 minutes to the operative time. The incidence of POAF, mean time in POAF, and median length of stay in hospital were: AGP+ 21% vs AGP- 30%; AGP+ 298 minutes vs AGP- 514 minutes; AGP+ 5 days vs AGP- 6 days; respectively). Postoperative complications, medication use, and daily serum electrolyte profiles were similar in both groups. CONCLUSIONS This pilot study demonstrated the safety and feasibility of mapping and ablation of AGP during CABG with minimal added operative time. Results further suggest a potentially clinically significant effect on POAF. A multicentre trial is warranted.
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Modulação eletrofisiológica das aurículas e veias pulmonares: interação da estimulação simpática e parassimpática na inducibilidade de fibrilhação aguda auricular num modelo experimental in vivo. Rev Port Cardiol 2012; 31:215-23. [DOI: 10.1016/j.repc.2012.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 11/04/2011] [Indexed: 11/18/2022] Open
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Oliveira M, Postolache G, Geraldes V, Silva V, Laranjo S, Tavares C, Nogueira da Silva M, Ferreira R, Rocha I. Acute electrophysiological modulation of the atria and pulmonary veins: Effects of sympathetic and parasympathetic interaction on atrial fibrillation inducibility. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2012. [DOI: 10.1016/j.repce.2012.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Maesen B, Nijs J, Maessen J, Allessie M, Schotten U. Post-operative atrial fibrillation: a maze of mechanisms. Europace 2011; 14:159-74. [PMID: 21821851 PMCID: PMC3262403 DOI: 10.1093/europace/eur208] [Citation(s) in RCA: 285] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Post-operative atrial fibrillation (POAF) is one of the most frequent complications of cardiac surgery and an important predictor of patient morbidity as well as of prolonged hospitalization. It significantly increases costs for hospitalization. Insights into the pathophysiological factors causing POAF have been provided by both experimental and clinical investigations and show that POAF is ‘multi-factorial’. Facilitating factors in the mechanism of the arrhythmia can be classified as acute factors caused by the surgical intervention and chronic factors related to structural heart disease and ageing of the heart. Furthermore, some proarrhythmic mechanisms specifically occur in the setting of POAF. For example, inflammation and beta-adrenergic activation have been shown to play a prominent role in POAF, while these mechanisms are less important in non-surgical AF. More recently, it has been shown that atrial fibrosis and the presence of an electrophysiological substrate capable of maintaining AF also promote the arrhythmia, indicating that POAF has some proarrhythmic mechanisms in common with other forms of AF. The clinical setting of POAF offers numerous opportunities to study its mechanisms. During cardiac surgery, biopsies can be taken and detailed electrophysiological measurements can be performed. Furthermore, the specific time course of POAF, with the delayed onset and the transient character of the arrhythmia, also provides important insight into its mechanisms. This review discusses the mechanistic interaction between predisposing factors and the electrophysiological mechanisms resulting in POAF and their therapeutic implications.
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Affiliation(s)
- Bart Maesen
- Department of Cardiothoracic Surgery, University Hospital of Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands
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Latchamsetty R, Oral H. Thoracoscopic surgical treatment of atrial fibrillation with electrophysiologic end points. Circ Arrhythm Electrophysiol 2011; 4:255-6. [PMID: 21673022 DOI: 10.1161/circep.111.963843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Salehi Omran A, Karimi A, Ahmadi H, Yazdanifard P, Sheikh Fahtollahi M, Tazik M. Prophylactic ventral cardiac denervation: Does it reduce incidence of atrial fibrillation after coronary artery bypass grafting? J Thorac Cardiovasc Surg 2010; 140:1036-9. [DOI: 10.1016/j.jtcvs.2009.12.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Revised: 11/18/2009] [Accepted: 12/09/2009] [Indexed: 10/19/2022]
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Nishida K, Maguy A, Sakabe M, Comtois P, Inoue H, Nattel S. The role of pulmonary veins vs. autonomic ganglia in different experimental substrates of canine atrial fibrillation. Cardiovasc Res 2010; 89:825-33. [DOI: 10.1093/cvr/cvq332] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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Enríquez F, Jiménez A. Taquiarritmias postoperatorias en la cirugía cardíaca del adulto. Profilaxis. CIRUGIA CARDIOVASCULAR 2010. [DOI: 10.1016/s1134-0096(10)70100-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kaireviciute D, Aidietis A, Lip GYH. Atrial fibrillation following cardiac surgery: clinical features and preventative strategies. Eur Heart J 2009; 30:410-25. [PMID: 19174427 DOI: 10.1093/eurheartj/ehn609] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Atrial fibrillation (AF) is a common complication of cardiac surgery, with an increasing incidence. Post-operative AF results in many complications and increased healthcare resources. Despite substantial interest in the prediction and prevention of post-operative AF, as well as guidelines for the management of this common arrhythmia, there is still some uncertainty about appropriate risk stratification and management. The aim of this review article is to provide an overview of clinical predictive features for the development of AF following cardiac surgery and suitable preventive measures, using both antiarrhythmic and non-antiarrhythmic strategies.
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Affiliation(s)
- Diana Kaireviciute
- Haemostasis, Thrombosis, and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK
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Ablation of Ganglionic Plexi During Combined Surgery for Atrial Fibrillation. Ann Thorac Surg 2008; 86:1659-63. [DOI: 10.1016/j.athoracsur.2008.06.077] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Revised: 05/26/2008] [Accepted: 06/02/2008] [Indexed: 11/19/2022]
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22
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SCHERLAG BENJAMINJ, HOU YINGLONG, LIN JIAXIONG, LU ZHIBING, ZACHARIAS SONI, DASARI TARUN, NIU GUODONG, GHIAS MUHAMMAD, PATTERSON EUGENE, JACKMAN WARRENM, LAZZARA RALPH, PO SUNNYS. An Acute Model for Atrial Fibrillation Arising from a Peripheral Atrial Site: Evidence for Primary and Secondary Triggers. J Cardiovasc Electrophysiol 2008; 19:519-27. [DOI: 10.1111/j.1540-8167.2007.01087.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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23
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Surgical feasibility of the injection of fibrin sealant in cardiac fat pads to reduce the incidence of postoperative atrial fibrillation after coronary artery bypass grafting or valve surgery: a pilot study. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2008; 3:151-4. [PMID: 22436857 DOI: 10.1097/imi.0b013e31817f82e6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE : Atrial fibrillation (AF) is the most common complication following coronary artery bypass grafting or valve surgery.The autonomic nervous system is an important determinant in the development of AF. We have assessed the role of injection of fibrin sealant (FS) as a method to modify conduction in the fad pads, to mimic temporary denervation and to reduce the incidence of postoperative AF in patients undergoing coronary artery bypass grafting or valve surgery. PATIENTS AND METHODS : Twenty eligible patients who underwent coronary bypass grafting or aortic valve surgery in our Institution were included in this pilot - study.Detection of AF after surgical intervention was based on patient symptomatology and on daily electrocardiograms obtained on all patients. Telemetry was used in all patients for the entire hospitalization period. RESULTS : 20% of the studied population (n = 4) developed postoperative AF. At the time of discharge one patient (5%) had persistent AF.Postoperative mortality was 5% (n = 1) and not cardiac related. None of the patients required permanent pacemaker implantation. CONCLUSIONS : This first human study of FS injected into the anterior fad pads following low to moderate risk open heart surgery shows, that this procedure is safe and feasible. Moreover, CM -1 injection appears to reduce the need for postoperative intervention and/or treatment of AF by diminishing its incidence.
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Chryssagis K, Klügl S, Liangos A, Gutleben KJ, Brachmann J, Diegeler A. Surgical Feasibility of the Injection of Fibrin Sealant in Cardiac Fat Pads to Reduce the Incidence of Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting or Valve Surgery: A Pilot Study. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2008. [DOI: 10.1177/155698450800300308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Stefan Klügl
- Department of Cardiovascular Surgery, Rhoen Klinikum, Bad Neustadt
| | - Aris Liangos
- Department of Cardiovascular Surgery, Rhoen Klinikum, Bad Neustadt
| | | | | | - Anno Diegeler
- Department of Cardiovascular Surgery, Rhoen Klinikum, Bad Neustadt
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Oral H, Morady F. Autonomic Innervation, Atrial Electrogram Morphology, and Atrial Fibrillation⁎⁎Editorials published in the Journal of the American College of Cardiologyreflect the views of the authors and do not necessarily represent the views of JACCor the American College of Cardiology. J Am Coll Cardiol 2007; 50:1332-4. [PMID: 17903631 DOI: 10.1016/j.jacc.2007.04.098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Accepted: 04/10/2007] [Indexed: 11/26/2022]
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26
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Hsieh MH, Chen SA. Introduction to catheter ablation of atrial fibrillation: an overview. Heart Rhythm 2007; 4:S40-3. [PMID: 17336883 DOI: 10.1016/j.hrthm.2006.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2006] [Indexed: 11/24/2022]
Affiliation(s)
- Ming-Hsiung Hsieh
- Division of Cardiovascular Medicine, Department of Medicine, Taipei Medical University-Wan Fang Hospital, Taipei, Republic of China
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Ootaki Y, Kamohara K, Akiyama M, Zahr F, Kopcak MW, Dessoffy R, Fukamachi K. Ventral cardiac denervation increased right coronary arterial blood flow. Int J Cardiol 2007; 114:309-14. [PMID: 16797752 DOI: 10.1016/j.ijcard.2005.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2005] [Revised: 12/12/2005] [Accepted: 12/14/2005] [Indexed: 11/20/2022]
Abstract
BACKGROUND Cardiac denervation accompanied with coronary artery bypass surgery has been widely performed for the treatment of vasospastic angina associated with atherosclerotic coronary artery disease. However, the effect of cardiac denervation on phasic coronary blood flow patterns of the left anterior descending coronary artery (LAD), left circumflex coronary artery (LCX) and right coronary artery (RCA) remains unknown. This study aimed to investigate the effect of cardiac denervation on phasic coronary blood flow patterns of the LAD, LCX and RCA. METHODS Phasic coronary blood flow patterns were analyzed using three flow probes placed around the LAD, LCX and RCA with and without LAD stenosis. Ventral cardiac denervation (VCD) was performed in 8 pigs, and 16 pigs were used as control subjects. Autonomic activities before and after the VCD were quantified by wavelet analysis of heart rate variability. RESULTS The mean LAD flow (34.4+/-9.4 to 32.6+/-7.1 ml/min, p=0.638) and mean LCX flow (26.3+/-10.2 to 27.2+/-6.0 ml/min, p=0.825) showed no significant change after VCD, while the mean RCA flow (31.3+/-9.0 to 38.2+/-11.2 ml/min, p=0.003) significantly increased. The hemodynamic variables in the VCD group were well maintained after creation of LAD stenosis, while they deteriorated in the control group. The low-frequency components, high-frequency components and their ratio did not change after VCD. CONCLUSIONS VCD prevented the deterioration of cardiac function after creation of an LAD stenosis and resulted in an increase of the mean RCA flow. VCD did not affect autonomic nervous system activity.
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Affiliation(s)
- Yoshio Ootaki
- Department of Biomedical Engineering, Lerner Research Institute, The Cleveland Clinic, Cleveland, Ohio, USA
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Bakir I, Casselman FP, Brugada P, Geelen P, Wellens F, Degrieck I, Van Praet F, Vermeulen Y, De Geest R, Vanermen H. Current strategies in the surgical treatment of atrial fibrillation: review of the literature and Onze Lieve Vrouw Clinic's strategy. Ann Thorac Surg 2007; 83:331-40. [PMID: 17184704 DOI: 10.1016/j.athoracsur.2006.07.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2006] [Revised: 07/15/2006] [Accepted: 07/18/2006] [Indexed: 10/23/2022]
Abstract
Atrial fibrillation is the most common rhythm disturbance in clinical practice. It is a major source of stroke and morbidity. Although the Cox maze procedure effectively eliminates atrial fibrillation in most patients, the procedure has not found widespread application. As a consequence, new operations that use alternative sources of energy, such as radiofrequency, microwave, cryothermy, laser, and ultrasound have emerged to surgically create lesion sets to treat atrial fibrillation. This article reviews the fundamentals and current strategies in the surgical treatment of atrial fibrillation.
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Affiliation(s)
- Ihsan Bakir
- Cardiovascular and Thoracic Surgery Department, Onze Lieve Vrouw Clinic, Aalst, Belgium
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Dunning J, Treasure T, Versteegh M, Nashef SAM. Guidelines on the prevention and management of de novo atrial fibrillation after cardiac and thoracic surgery. Eur J Cardiothorac Surg 2006; 30:852-72. [PMID: 17070065 DOI: 10.1016/j.ejcts.2006.09.003] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Revised: 07/28/2006] [Accepted: 09/04/2006] [Indexed: 11/29/2022] Open
Affiliation(s)
- Joel Dunning
- James Cook University Hospital, Middlesbrough, UK
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Simple Amiodarone Protocol Reduces Postoperative Atrial Fibrillation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2006. [DOI: 10.1177/155698450600100510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Oh S, Zhang Y, Bibevski S, Marrouche NF, Natale A, Mazgalev TN. Vagal denervation and atrial fibrillation inducibility: Epicardial fat pad ablation does not have long-term effects. Heart Rhythm 2006; 3:701-8. [PMID: 16731474 DOI: 10.1016/j.hrthm.2006.02.020] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2005] [Accepted: 02/14/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Major epicardial fat pads contain cardiac ganglionated plexi of the autonomic, predominantly vagal nerves. Vagal denervation may improve the success rate of atrial fibrillation (AF) treatment. OBJECTIVES The purpose of this study was to elucidate the long-term effects of fat pad ablation on the electrophysiologic characteristics of the atrium and AF inducibility. METHODS Six mongrel dogs were studied. Cervical vagal stimulation was applied to determine effects on the sinus node, AV node, atrial effective refractory period (AERP), and AF inducibility. AERP and AF inducibility were evaluated at both the right atrial and left atrial appendages and at the right atrial and left atrial free walls. Radiofrequency energy was delivered epicardially to the entire areas of two major fat pads: right pulmonary vein fat pad and inferior vena cava-left atrium fat pad. Cervical vagal stimulation then was applied to confirm the acute effects of fat pad ablation. The same evaluation was repeated 4 weeks later. RESULTS The effects of vagal stimulation on the sinus node, AV node, and AERP were significantly eliminated immediately after fat pad ablation. However, these denervation effects disappeared after 4 weeks. At baseline, AF inducibility was increased by vagal stimulation (right atrial appendage: 72% +/- 31% vs 4.8% +/- 12%; right atrial free wall: 75% +/- 31% vs 0.0% +/- 0.0%; left atrial appendage: 60% +/- 29% vs 0.0% +/- 0.0%; left atrial free wall: 65% +/- 42% vs 0.0% +/- 0.0%). Fat pad ablation significantly reduced this vagal stimulation effect (8.3% +/- 20%, 10% +/- 22%, 17% +/- 29%, and 25% +/- 29%, respectively). However, similar to baseline, AF inducibility was strongly augmented by vagal stimulation 4 weeks after fat pad ablation (96% +/- 10%, 100% +/- 0.0%, 100% +/- 0.0%, and 95% +/- 11%, respectively). CONCLUSION Radiofrequency fat pad ablation may not achieve long-term suppression of AF induction in this canine model.
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Affiliation(s)
- Seil Oh
- Section of Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic, Ohio 44195, USA
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Mounsey JP. Recovery from vagal denervation and atrial fibrillation inducibility: effects are complex and not always predictable. Heart Rhythm 2006; 3:709-10. [PMID: 16731475 DOI: 10.1016/j.hrthm.2006.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2006] [Indexed: 11/18/2022]
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Amar D, Zhang H, Heerdt PM, Park B, Fleisher M, Thaler HT. Statin use is associated with a reduction in atrial fibrillation after noncardiac thoracic surgery independent of C-reactive protein. Chest 2005; 128:3421-7. [PMID: 16304294 DOI: 10.1378/chest.128.5.3421] [Citation(s) in RCA: 156] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES The level of C-reactive protein (CRP) has been shown to be elevated in patients with atrial fibrillation/flutter (AF) unrelated to surgery, and statins are known to lower the CRP level. To determine whether an elevated CRP level predisposes the patient to postoperative AF and whether statin use is associated with a reduced AF incidence, we studied a consecutive group of patients who were at risk for AF after undergoing thoracic surgery (age, > or = 60 years). DESIGN AND SETTING A prospective study in a tertiary care cancer center of 131 patients (mean [+/- SD] age, 73 +/- 6 years) who had undergone major lung or esophageal resection. High-sensitivity CRP and interleukin (IL)-6 levels were measured before surgery, on arrival at the postanesthesia care unit, and on the first morning after surgery. Continuous telemetry was used for 72 to 96 h to detect AF. RESULTS AF occurred in 38 of 131 patients (29%) at a median time after surgery of 3 days. Although CRP and IL-6 levels increased significantly (p < 0.001) in response to surgery, patients with or without AF did not differ in perioperative values. In a stepwise logistic regression, statin use was associated with a threefold decrease in the odds of developing AF (odds ratio [OR], 0.26; 95% confidence interval [CI], 0.08 to 0.82; p = 0.022) and a greater PR interval (OR, 1.11 per 5-ms increments; 95% CI, 1.01 to 1.22; p = 0.027) predicted an increase in the risk of AF. CONCLUSIONS The preoperative use of statins was associated with a protective effect against postoperative AF independent of CRP levels. In contrast to AF in the general population, early markers of inflammation did not predict the postoperative occurrence of AF.
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Affiliation(s)
- David Amar
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia seen after cardiac surgery. It is associated with prolongation of hospital stay, postoperative complications, stroke, mortality, and increased hospital cost. Several prevention strategies have been proven effective in reducing postoperative AF; in addition, active prevention of postoperative AF is associated with a decrease in the length of hospital stay and a reduction trend in hospital costs. In patients with postoperative AF, restoration and maintenance of sinus rhythm and rate control are adequate treatment alternatives in the majority of cases. In severely symptomatic or hemodynamically compromised patients urgent cardioversion is needed. Adequate oral anticoagulation may be indicated for a limited period of time.
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Affiliation(s)
- Orhan Onalan
- Arrhythmia Services, Division of Cardiology, Sunnybrook and Women's College Health Sciences Centre, 2075 Bayview Avenue, A253, Toronto, ON M4N 3M5, Canada
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Abstract
Recent clinical studies performed in human subjects have provided important clues that improved our understanding of the mechanisms of atrial fibrillation (AF) and facilitated development of new treatment strategies. When analyzed together, these studies confirm the complexity and multifactorial nature of AF. Because a variety of mechanisms such as focal drivers within the thoracic veins, rotors in the left atrium, multiple reentrant circuits, and autonomic innervation may play a role in the initiation and maintenance of AF alone or in combination, the best strategy to eliminate AF may be the accurate identification of one or more of the mechanisms critical to the genesis of AF and to target the specific mechanism(s).
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Affiliation(s)
- Hakan Oral
- Division of Cardiovascular Medicine, University of Michigan Ann Arbor, MI, USA.
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36
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Jones RH. The Year in Cardiovascular Surgery. J Am Coll Cardiol 2005; 45:1517-28. [PMID: 15862428 DOI: 10.1016/j.jacc.2005.02.064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2005] [Revised: 02/25/2005] [Accepted: 03/01/2005] [Indexed: 11/25/2022]
Affiliation(s)
- Robert H Jones
- Department of Surgery/Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina 27715, USA.
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Alex J, Guvendik L. Evaluation of Ventral Cardiac Denervation As a Prophylaxis Against Atrial Fibrillation After Coronary Artery Bypass Grafting. Ann Thorac Surg 2005; 79:517-20. [PMID: 15680826 DOI: 10.1016/j.athoracsur.2004.08.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2004] [Indexed: 11/28/2022]
Abstract
BACKGROUND To evaluate the efficacy of ventral cardiac denervation as a prophylaxis against post-coronary artery bypass grafting (CABG) atrial fibrillation (AF). METHODS Seventy consecutive patients who underwent CABG (group A) were compared to 70 consecutive subsequent patients who underwent CABG + ventral cardiac denervation (group B). Both groups were well-matched for age, gender, disease severity, LV function, Euro scores, Parsonnet scores, preoperative beta-blockers, Ca-channel blockers, digoxin, and angiotensin converting enzyme inhibitors. The same cardioplegia, bypass, and operation techniques were used in all cases. Denervation before initiating bypass increased operation time by approximately 5 minutes. Heart rate and rhythm were monitored by continuous telemetry until postoperative day 5 and then 4- hourly until discharge. RESULTS The cross-clamp time (p = 0.6), bypass time (p = 0.1), number of grafts (p = 0.9), inotrope usage (p = 0.4), reexploration rate (p = 1), postoperative myocardial infarction (none in either group), blood loss (p = 0.7), and length of stay (p = 0.8) were comparable in both groups. There was no significant difference in the incidence of AF; 34% in group A versus 29% in group B (p = 0.3). CONCLUSIONS Ventral cardiac denervation failed to significantly reduce the incidence of AF following coronary revascularization in our study.
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Affiliation(s)
- Joseph Alex
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull, United Kingdom.
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Alex J, Rehman MU, Guvendik L. Ventral cardiac denervation: Is it truly an effective prophylaxis against atrial fibrillation after coronary artery bypass grafting? J Thorac Cardiovasc Surg 2004; 128:326-7. [PMID: 15282476 DOI: 10.1016/j.jtcvs.2004.03.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Saltman AE. New-onset postoperative atrial fibrillation: A riddle wrapped in a mystery inside an enigma. J Thorac Cardiovasc Surg 2004; 127:311-3. [PMID: 14762334 DOI: 10.1016/j.jtcvs.2003.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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