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Background: Postoperative atrial fibrillation (POAF) is frequently observed after cardiac surgery, and duration of Bypass Time (CPB) is an independent risk factor for postoperative atrial fibrillation (POAF). The main objective of the current study was to compare new onset Postoperative Atrial Fibrillation (POAF) in patients undergoing coronary artery bypass graft with and without long CPB time. Methods: A prospective comparative study design was used and conducted at the Cardiac Surgery Department in Bahawalpur- Pakistan which is a tertiary care health centre for the period of April 2020 to February 2021, a total of 110 patients were enrolled after getting institutional approval and informed consent from patients. The ethical protocol was followed throughout the study period. Data was entered and analyzed using SPSS version 25.0 and p-value <0.05 taking the level of significance. Results: A total of 110 patients were enrolled for the research, the average age of patients was 48.56±3.11 (age range 30-70), and there were 38 (34.55%) & 72 (65.45%) male and female patients observed respectively. The atrial fibrillation developed in 3 (5.45) patients in without a long CPB time group as compared with the long CPB time group as 8(14.54%) with a statistically significant p-value of 0.043, postoperative IABP support with an insignificant p-value of 0.234. Conclusion: Postoperative atrial fibrillation in patients undergoing coronary artery bypass graft is significantly higher with long CPB time as compared with without long CPB time. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is the most common post-operative complication and tends to be the most common arrhythmia after cardiac surgery. The etiology and risk factors for post-operative AF are poorly understood, but older age, large left atrium, diffuse coronary artery disease, a history of AF paroxysms and in general, pre-existing cardiac conditions that cause restricting and susceptibility towards inflammation have been consistently linked with post-operative atrial fibrillation (POAF). It has been traditionally thought that post-operative AF is transient, well-tolerated, benign to the patient and self-limiting complication of cardiac surgery that was temporary and easily treated. However, recent evidence suggests that POAF may be more "malignant" than previously thought, associated with follow-up mortality and morbidity. Several minimally invasive approaches, including the right parasternal approach, upper and lower mini-sternotomy (MS), V-shaped, Z-shaped, inverse-T, J-, reverse-C and reverse-L partial MS, transverse sternotomy and right mini-thoracotomy, have been developed for cardiac surgery operations since 1993 and have been associated with better outcomes and lower perioperative morbidity compared to full sternotomy (FS). The common goal of several minimally invasive approaches is to reduce invasiveness and surgical trauma. According to a statement from the American Heart Association (AHA), the term "minimally invasive" refers to a small chest wall incision that does not include a FS. This review is aimed to evaluate the use of minimally invasive techniques like mini-sternotomy, mini-thoracotomy and hybrid techniques versus conventional techniques which are used in cardiac surgery and to compare the frequency of post-operative AF and its effect on post-operative complications, morbidity and mortality, after cardiac surgery operations with FS versus cardiac surgery operations with the use of minimally invasive techniques. [ABSTRACT FROM AUTHOR]

Background: The aim of our study was the identification of genetic variants associated with postoperative complications after cardiac surgery.Methods: We conducted a prospective, double-blind, multicenter, randomized trial (RIPHeart). We performed a genome-wide association study (GWAS) in 1170 patients of both genders (871 males, 299 females) from the RIPHeart-Study cohort. Patients undergoing non-emergent cardiac surgery were included. Primary endpoint comprises a binary composite complication rate covering atrial fibrillation, delirium, non-fatal myocardial infarction, acute renal failure and/or any new stroke until hospital discharge with a maximum of fourteen days after surgery.Results: A total of 547,644 genotyped markers were available for analysis. Following quality control and adjustment for clinical covariate, one SNP reached genome-wide significance (PHLPP2, rs78064607, p = 3.77 × 10- 8) and 139 (adjusted for all other outcomes) SNPs showed promising association with p < 1 × 10- 5 from the GWAS.Conclusions: We identified several potential loci, in particular PHLPP2, BBS9, RyR2, DUSP4 and HSPA8, associated with new-onset of atrial fibrillation, delirium, myocardial infarction, acute kidney injury and stroke after cardiac surgery.Trial Registration: The study was registered with ClinicalTrials.gov NCT01067703, prospectively registered on 11 Feb 2010. [ABSTRACT FROM AUTHOR]

OBJECTIVES To compare the outcomes of left atrial ablation and biatrial (BA) ablation in patients with persistent and long-standing persistent atrial fibrillation undergoing open heart surgery. METHODS Between January 2007 and December 2016, 588 consecutive patients with either persistent (20.9%) or long-standing persistent atrial fibrillation (79.1%) were enrolled in this study. To reduce between-group differences, propensity score-matched groups (156 patients/group) were obtained, with similar preoperative and perioperative characteristics. RESULTS The propensity score-matched left atrial and BA groups did not differ regarding 30-day mortality (1.9% vs 0.6%; P  = 0.617), 5-year overall survival (93.5 ± 2.2% vs 92.8 ± 2.9%, P  = 0.998) or survival free from thromboembolic events (97.1 ± 2.8% vs 96.2 ± 2.7%, P  = 0.309). The BA lesion set was more beneficial in terms of freedom from atrial arrhythmia recurrence (85.3 ± 4.5% vs 91.9 ± 3.1%, P  = 0.049; hazard ratio 3.26; 95% confidence interval 1.33–7.99), but it was associated with higher pacemaker implantation rate (3.8% vs 17.3%; P  < 0.001) due to sinus node dysfunction. There was no significant between-group difference regarding the incidence of atrioventricular conduction disturbances (3.2% vs 7.0%, respectively; P  = 0.211). CONCLUSIONS The 2 lesion sets (left atrial and BA) are associated with similar 30-day mortality, survival rates, incidences of embolic events and atrioventricular conduction disturbances. In patients with persistent atrial fibrillation, concomitant surgical ablation with BA lesion set provided better freedom from atrial arrhythmia recurrence, but BA ablation was associated with a higher incidence of sinus node dysfunction and a higher rate of pacemaker implantation. [ABSTRACT FROM AUTHOR]

Introduction: Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery associated with increased morbidity and mortality. Although sustained hyperglycemia is a known risk factor of AF and poor ICU outcomes, emerging in-vitro studies reveal acute glycemic fluctuations to be an additional independent predictor of AF. The effect of acute glycemic fluctuations on the incidence of POAF in the clinical setting remains unclear. We aim to investigate the effect of the magnitude of acute perioperative glycemic fluctuations on the incidence of POAF in a multi-ethnic Southeast-Asian population. Methods: We obtained data from1743 patients who underwent elective CABG in a tertiary heart centre from 2009–2011. Patients were kept to a tight baseline glycemic control in accordance with hospital protocol. The magnitude of the difference between the highest and lowest perioperative glucose levels up till the first 48 postoperative hours was employed as a measure of glycemic fluctuation. Patients were divided into 4 groups for analysis based on the magnitude of glycemic fluctuation:A)0-2mmol/L(N = 147); B)>2-4mmol/L(N = 426); C)>4-6mmol/L(N = 513); D)>6mmol/L(N = 657).Our primary outcome was the incidence of POAF. Secondary outcomes included ICU and 30-day mortality and length of stay. Results: The overall incidence of POAF was 14.7%. This increased as the magnitude of glycemic fluctuation increased, and was statistically highest in Group D(16.4%) as compared with the other 3 sub-groups. Multivariate logistic regression revealed the magnitude of perioperative glycemic fluctuation to be an independent risk factor of POAF(O.R.1.06, 95% C.I.1.01–1.11, p = 0.014).ICU length of stay was statistically highest in Group D(63.1 hours, p = < .001). However, ICU and 30 day mortality rates were similar among the 4 groups. Conclusion: Increased magnitudes of acute perioperative glycemic fluctuations are associated with a significantly increased risk of POAF and length of ICU stay; and should therefore be minimised but balanced against the risks of hypoglycemia so as to avoid POAF and optimise patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: Postoperative atrial fibrillation (POAF) is the most common complication following cardiac surgery, with increased risk of stroke and high mortality. Our aim was to identify patients at risk and to design a model that could predict POAF. Methods: In this single center study, we evaluated 1191 patients requiring isolated surgical aortic valve replacement between January 2000 and June 2014. The patients were followed during the early postoperative period until discharge. Results: AF occurred in 342 patients (28.71%). Six variables associated with high arrhythmic risk [advanced age, body mass index, tricuspid regurgitation, prolonged ventilation, longer intensive care unit stay, and dilated left atrium (LA; volume ≥35 ml/m2)] were selected to create a multivariate prediction model. This model predicted POAF in 64.7% of cases, with a moderate discriminative power (AUC=0.65; p=0.001; 95% CI, 0.571-0.771). We also developed the CHAID (Chi-square automatic interaction detection) model showing multilevel interactions among risk factors for POAF. Age had the greatest discriminative power, with patients aged >68 years at a higher risk for POAF. In low-risk patients, the subgroup with dilated LA (volume ≥40 ml) was more prone to develop POAF. For the intermediate-risk group, history of AF was the next deciding variable, whereas for the high-risk group, it was tricuspid regurgitation (at least moderate). Conclusion: The multivariate logistic model has an acceptable predictive value. CHAID-derived model is a new tool that could be easily applied to identify patients requiring prophylactic regimens. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Atrial fibrillation (AF) is common in patients with hypertrophic cardiomyopathy (HCM) and it is often poorly tolerated because of loss of atrial contraction and reduced filling time with rapid ventricular rates. Restoring sinus rhythm is of great clinical benefit to HCM patients. Very few data exist regarding surgical ablation of concomitant AF in this setting. The aim of this study was to evaluate the mid-term outcome of surgical AF ablation in patients who underwent cardiac surgery due to HCM. METHODS: Thirty-one consecutive patients with primary HCM and drug-refractory symptomatic AF underwent surgical ablation with concomitant septal myectomy (77%) and/or mitral valve repair/replacement (39%). Follow-up was 97% complete with a median of 6.4 years [3.8-9.1]. RESULTS: Hospital mortality was 6% and the overall survival at 7 years was 87 ± 6.1%. No stroke and thromboembolic events were documented at follow-up. The arrhythmia-free survival off antiarrhythmic drugs was 82 ± 7.3% at 1 year and 52 ± 10.2% at 6 years. The 1- and 6- year arrhythmia control (maintenance of sinus rhythm with or without antiarrhythmic drugs) was 96 ± 3.5 and 80 ± 8.1%, respectively. The recurrent arrhythmia was AF in all patients. No predictors of AF recurrence were detected. CONCLUSIONS: Concomitant surgical ablation of AF is a reasonable treatment option for drug refractory AF in patients with HCM undergoing surgical myectomy and/or mitral valve surgery. However, chronic antiarrhythmic drugs are needed to achieve a satisfactory mid-term arrhythmia control. [ABSTRACT FROM AUTHOR]

Introduction: Atrial fibrillation (AF) is a frequently encountered complication after coronary artery bypass grafting (CABG), but its underlying mechanisms are still unclear. The natriuretic peptides have been reported as markers for predicting the occurrence of postoperative AF. This study evaluates whether the ScaI ANP gene polymorphisms predict the occurrence of postoperative AF. Material and methods: A prospective study of 203 consecutive patients with coronary artery disease undergoing elective CABG was undertaken for atrial natriuretic peptide (ANP) ScaI gene polymorphism. Several perioperative data were analysed. Postoperative AF was defined as lasting for at least 15 min, confirmed by 12-lead ECG and occurring within 6 postoperative days. The ScaI polymorphism of the ANP gene was determined by polymerase chain reaction (PCR). Size-dependent separation of the PCR products on a polyacrylamide gel was followed by staining with ethidium bromide. Results: The total frequency of AF was 19.7%. The frequencies of ScaI ANP gene polymorphisms were as follows: A1A1 4.90%, A1A2 59.60% and A2A2 35.46%. In order to assess the hypothesis that the A2 allele is a marker of increased risk of postoperative atrial fibrillation, the odds ratio (OR) was calculated: A2 vs. non-A2, OR = 0.98 (0.23-4.1), p = 0.97, which was not significant. The odds ratios for A2A2 and A1A1 were not significant either: A2A2 vs. non-A2A2, OR = 1.11 (0.54-2.29), p = 0.76, and A1A1 vs. non-A1A1, OR = 1.17 (0.23-5.92), p = 0.84. Conclusions: ANP genotype did not predispose to the incidence of "new-onset" AF. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Emergent and late conversions form OFF-to-ON pump coronary artery bypass grafting (CABG) have been associated with worse outcomes, however, it remains unclear as to which risk factors are associated with conversion and how to prevent them. METHODS: Among 4718 patients who randomly underwent off- or on-pump CABG, the incidence of off-pump to on-pump cross-over, or 'OFF-to-ON conversion', was 7.9% (186/2356). The primary outcome was a composite of death, stroke, myocardial infarction, or new renal failure requiring dialysis. We assessed the risk factors and outcomes of converted patients. RESULTS: Emergent OFF-to-ON conversions, defined as conversions for hypotension or ischaemia, were required for 3.2% of patients (n = 75), while most elective conversions were due to small or intramuscular coronaries (n = 83). OFF-to-ON converted patients required increased surgery time, blood transfusions, intensive care unit stay, and presented a higher incidence at 1 year of the composite outcome compared with non-converted off-pump patients (all P< 0.01), especially if the conversion was emergent. Conversely, elective conversions outcomes were no different compared with non-converted off-pump patients (P = 0.35). Independent predictors of emergent conversions included higher heart rate or chronic atrial fibrillation, urgent surgery, more grafts planned and surgeon experience with off-pump CABG. CONCLUSION: Emergent OFF-to-ON conversion is associated with worse outcomes compared with elective conversion or no conversion. In the presence of risk factors for emergent conversion, an early and elective conversion approach is a judicious strategy. [ABSTRACT FROM AUTHOR]

Background: Allogeneic red blood cell (RBC) transfusion has been associated with new-onset postoperative atrial fibrillation (POAF) following cardiac surgery. Prolonged storage time of RBC may increase the risk. The primary aim of the study was to evaluate whether the storage time of RBC is associated with development of POAF. Materials and methods: Pre-, per- and postoperative data were retrieved from the Western Denmark Heart Registry and local blood banks regarding patients who underwent coronary artery bypass surgery, valve surgery or combined procedures in Aalborg or Aarhus University Hospital during 2010–2014. Multiple logistic regression was used to determine the risk of POAF according to transfusion of RBC on the day of surgery. Furthermore, we determined trend in storage time of RBC according to risk of POAF using restricted cubic splines. Patients with a history of preoperative atrial fibrillation, patients who received transfusions preoperative and patients who died at the day of surgery were among excluded patients. Results: A total of 2,978 patients with a mean age of 66.4 years were included and 609 patients (21%) received RBC transfusion on the day of surgery. POAF developed in 752 patients (25%) and transfused patients were at an increased risk compared with non-transfused patients (adjusted Odds Ratios for patients receiving RBC: 1.37; 95% CI: 1.11–1.69, P-value = 0.004). However, RBC transfusion was not necessarily the cause of POAF and may only be a marker for development of POAF. There was no significant association between storage time of RBC and POAF. Conclusions: In contrast to intraoperative allogeneic RBC transfusion in general, increased storage time of RBC is not associated with development of POAF in cardiac surgery. [ABSTRACT FROM AUTHOR]

Whereas the left atrial appendage plays a rather minor role under physiological circumstances, it gains an importance in patients with atrial fibrillation. Compelling evidence has revealed that the left atrial appendage is implicated as the source of thrombus in the vast majority of strokes in atrial fibrillation. Oral anticoagulation remains the standard of care for stroke prevention in atrial fibrillation; nevertheless, this treatment has several limitations and is often contraindicated, particularly in the elderly population in whom the risk of stroke is high. Therefore, occluding the left atrial appendage is a logical approach to prevent thrombus formation and subsequent cardioembolic events in these patients. We present a review of clinical outcomes of patients with atrial fibrillation undergoing left atrial appendage closure and the challenges faced in this field. [ABSTRACT FROM AUTHOR]

Introduction Post-operative atrial fibrillation (POAF) is one of the most common complications following cardiac surgery. However, it is unclear whether there is a relationship between obesity and POAF. We thus assessed all available evidence investigating the association between obesity and POAF, also considering any link between POAF and other post-operative conditions such as mortality, stroke, myocardial infarctions and respiratory complications. Methods Five electronic databases were searched and relevant studies were identified. Data was extracted and meta-analyzed from the identified studies. Results We found that obese patients had significantly higher odds of POAF when compared with non-obese patients (P = 0.006). There was also significant heterogeneity among the identified studies. POAF when compared with no-POAF was associated with an increased risk of stroke (P < 0.0001), 30-day mortality (P = 0.005) and respiratory complications (P < 0.00001). However, we found no significant link between POAF and myocardial infarctions (P = 0.79). Conclusions Our findings suggest that obesity is associated with a moderately higher risk of POAF. While POAF is also associated with an increased incidence of stroke, 30-day mortality and respiratory complications, further studies must be conducted before conclusions can be made about the long-term outcomes. [ABSTRACT FROM AUTHOR]

Background: We investigated the impact and the predictive value of sinus rhythm at 12 months (SR12) on subscales of three different HrQoL questionnaires: SF-36., EuroQoL and MFI 20.Methods: Data of 125 cardiac surgery patients with pre-operative AF from our previous randomized trial were used. Based on their rhythm outcome patients were divided in two groups: SR12 or AF at 12 months follow up (non-SR12). All questionnaires were self-administered pre-operatively and at 3 months, 6 months and 12 months after surgery.Results: Synus rhytm at 12 months was predictive of improvement of SF36- mental score (MS, p = 0.021), Euro-QoL-MS (p = 0.009), VAS (p = 0.006), and MFI 20-MS (p = 0.009). We failed to find any significant interactions between SR12 and any of the other significant risk factors: age <65 years, paroxysmal type of AF and preoperative AF duration <12 months. In contrast, SR12 was not significant in predicting physical score (PS) subscales of any of the questionnaires (all, p > 0.05) which were predicted by age <65 years (SF36-PS, p = 0.029) by paroxysmal type of AF and age <65 years (Euro-QoL-PS, p = 0.017 and p = 0.04, respectively) and by AF duration <12 months, paroxysmal type of AF and age < 65 years (MFI 20-PS, p = 0.019, p = 0.020 and p = 0.015, respectively).Conclusions: Specific mental-related HrQoL scales are much more sensitive to sinus rhythm conversion. Sinus rithm mantainance shows significant effects on mental scores independently of other cofactors. Successful conversion to sinus rhythm after surgical ablation during cardiac surgery does not significantly affect phisical health related quality of life during 1 year follow up. [ABSTRACT FROM AUTHOR]

Objective To investigate the perioperative features of aged patients undergoing off-pump coronary artery bypass grafting (OPCABG) surgery, and identify the perioperative effect of advanced age on OPCABG. Method A total of 61 aged patients and 585 younger patients from August 2013 to June 2014 were enrolled in this study. The perioperative features were summarized, and the effects of advanced age on intraoperative variables, as well as the postoperative complications were identified using logistic regression analysis. Results The anastomosis time of the target coronary artery and intraoperative dosage of vasoconstrictor drugs was significantly longer or higher in the aged patients. The incidence of the postoperative complications, such as atrial fibrillation, repetitive mechanical ventilation, gastrointestinal dysfunction, and renal insufficiency, were significantly higher in the aged patients. The intubation time and postoperative hospital stay were significantly longer in the aged patients. No significant difference was found between the two groups in cardiocerebrovascular accident and mortality. Multivariate logistic regression analysis revealed advanced age was the independent risk factor for coronary artery anastomosis time, vasoconstrictor dosage, repeated mechanical ventilation, atrial fibrillation, gastrointestinal dysfunction, as well as the intubation time and hospital stay. Conclusion OPCABG in aged patients was safe and effective for avoiding a significant increase for cardiocerebrovascular accident and mortality. Relatively, the tolerance of aged heart to stimulation was poor. Atrial fibrillation, repetitive mechanical ventilation, and gastrointestinal dysfunction were more likely to occur in aged patients. Advanced age made intubation time and hospital stay prolonged significantly. [ABSTRACT FROM AUTHOR]

Background: Extra-pericardial tamponade is a rare life threatening condition that has not previously been reported in association with Wolf Mini-Maze procedures. In this case, atypical presentation of cardiac tamponade caused by postoperative anticoagulation resulted in a second hospitalization, a second surgery, and delayed recovery time. The goal of this case report is to increase awareness about a life threatening complication that can occur following minimally invasive cardiac surgery.Case Presentation: A 60 year old male with long standing essential hypertension, who was recently treated for atrial fibrillation utilizing the Wolf Mini-Maze procedure, experienced a postoperative international normalized ratio increase from 3.6 to 5.3 over the course of six days. Fifteen days postoperatively, the patient experienced mild exercise intolerance, his condition rapidly progressed to a constellation of symptoms including severe exercise intolerance, dyspnea, hypotension, and near syncope. A diagnosis of cardiac tamponade was made, and the patient was re-admitted to the hospital. Attempts to reverse his warfarin anticoagulation with fresh frozen plasma and vitamin K were unsuccessful after 24 h. Video-assisted thoracotomy was performed to relieve the tamponade, and during surgery he was diagnosed with extra-pericardial tamponade caused by an extensive hematoma. Complications due to anticoagulation therapy required this re-admission, additional surgery, and delayed recovery. The patient has since recovered completely with no long term morbidities and is asymptomatic three years following initial presentation.Conclusions: This case marks the first time extra-pericardial tamponade has been reported post cardiothoracic intervention in English literature. Many surgical procedures require postoperative anticoagulation; in the past, warfarin has been the standard of care due to its purported reversibility. This case provides an example of the challenge presented when anticoagulating with warfarin, and the reversal of this anticoagulation. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) occurs in 5%-14% of adults but is often undiagnosed. Apneas cause acute physiological changes, including alveolar hypoventilation and pulmonary artery vasoconstriction; they also promote chronic vascular disease secondary to increased platelet adhesiveness, endothelial dysfunction, and accelerated atherosclerosis. The Sleep Heart Health Study demonstrated that OSA is a risk factor for stroke and that an increase of 1 unit in the apnea-hypopnea index increases stroke risk by 6% in men. Patients with OSA frequently have atrial fibrillation (AF). Patients with OSA and AF have an increased incidence of stroke compared with patients with only OSA. The treatment of OSA with CPAP reduces the incidence of stroke and decreases the recurrence rate of AF in patients undergoing pulmonary vein ablation procedures. Undertreated OSA has the potential to complicate the postoperative course of patients undergoing cardiac surgery and increase the frequency of arrhythmias and ischemic events. However, one prospective study demonstrated that OSA did not increase complications during the first 30 days following surgery but increased complications during the long-term follow-up. OSA is associated with increased atherosclerotic coronary disease and the development of coronary events and congestive heart failure. In summary, patients with OSA have an increased frequency of stroke and AF. The treatment of these patients with CPAP reduces the frequency of stroke and AF recurrence rate in patients with AF undergoing either medical management or invasive procedures. However, well-designed clinical trials are necessary to answer critical questions regarding the management of OSA in patients with cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery that occurs in up to 60% of patients. POAF is associated with increased risk of cardiovascular mortality, stroke and other arrhythmias that can impact on early and long term clinical outcomes and health economics. Many factors such as disease-induced cardiac remodelling, operative trauma, changes in atrial pressure and chemical stimulation and reflex sympathetic/parasympathetic activation have been implicated in the development of POAF. There is mounting evidence to support a major role for inflammation and oxidative stress in the pathogenesis of POAF. Both are consequences of using cardiopulmonary bypass and reperfusion following ischaemic cardioplegic arrest. Subsequently, several anti-inflammatory and antioxidant drugs have been tested in an attempt to reduce the incidence of POAF. However, prevention remains suboptimal and thus far none of the tested drugs has provided sufficient efficacy to be widely introduced in clinical practice. A better understanding of the cellular and molecular mechanisms responsible for the onset and persistence of POAF is needed to develop more effective prediction and interventions. [ABSTRACT FROM AUTHOR]

Background: Atorvastatin has been demonstrated to reduce the incidence of postoperative atrial fibrillation (POAF) in patients undergoing cardiac surgery, but its effect on isolated heart valve surgery is unknown. Methods: In a randomized, double-blinded, placebo-controlled trial, 58 patients who underwent isolated heart valve surgery supported by on-pump cardiopulmonary bypass were randomly assigned to receive either placebo (n = 29) or 40 mg of atorvastatin once daily starting 3 days preoperatively and continuing within 5 days postoperatively (n = 29). A continuous monitoring tool and an electrocardiographic Holter monitoring were used for detecting the POAF (Clinical Trial Registration: www.clinicaltrials.gov; Unique Identifier: NTC02084069). Results: The patients’ median age was 49 years, and 67% were female. In all, 6 (21%) and 13 (45%) cases of POAF were observed in the atorvastatin and placebo groups, respectively (P = .050). The duration of AF before re-establishment of sinus rhythm was significantly lower in the atorvastatin group than in the placebo group (median of 70 vs 132 minutes, P = .026). The lengths of intensive care unit and hospital stay were comparable between the groups. The increase in postoperative white blood cell count was significantly lower in the atorvastatin group than in the placebo group (median of 1.5 vs 2.3 × 103/µL, respectively, P = .019). After adjustment, the atorvastatin treatment was associated with a decrease in the risk of developing POAF (odds ratio 0.122, 95% confidence interval 0.027-0.548, P = .006). Conclusion: Perioperative treatment with 40 mg of atorvastatin is useful to decrease the incidence of POAF in the statin-naive patients undergoing isolated heart valve surgery. [ABSTRACT FROM AUTHOR]

The aim of this study was to retrospectively investigate whether performing surgical atrial fibrillation (AF) ablation in conjunction with cardiac surgery (CS) increases the risk for postoperative permanent pacemaker (PPM) requirement. The 30-day risk for PPM requirement was analyzed in consecutive patients who underwent CS from January 2007 to August 27, 2013. Patients were divided into 3 groups: (1) those who underwent AF ablation concomitant with CS (AF ABL), (2) patients with any history of AF who underwent surgery who did not undergo ablation (AF NO ABL), and (3) those with no histories of AF who underwent surgery (NO AF). Logistic regression analysis was performed adjusting for age, gender, and surgery type. Of 13,453 CS patients, 353 (3%) were in the AF ABL group, 1,701 (12%) in the AF NO ABL group, and 11,399 (85%) in the NO AF group. A total of 7,651 patients (57%) underwent coronary artery bypass grafting, 4,384 (33%) underwent valve surgery, and 1,418 (10%) underwent coronary artery bypass grafting and valve surgery. The overall PPM risk was 1.6% (212 of 13,453); risk was 5.7% (20 of 353) in the AF ABL group, 3.1% (53 of 1,701) in the AF NO ABL group, and 1.2% (139 of 11,399) in the NO AF group. The unadjusted and adjusted odds of PPM were higher in the AF ABL and AF NO ABL groups than in the NO AF group (adjusted odds ratio [OR] 2.7, 95% confidence interval [CI] 1.7 to 4.4, and adjusted OR 1.7, 95% CI 1.2 to 2.4, respectively). The unadjusted OR comparing the AF ABL group and the AF NO ABL group was significant (unadjusted OR 1.9, 95% CI 1.9 to 3.2); however, the OR adjusted for surgery type, age, and gender showed a trend toward significance (adjusted OR 1.6, 95% CI 0.9 to 2.7). In conclusion, in this large cohort of patients who underwent CS, surgical AF ablation appeared to carry an increased risk for postoperative PPM implantation. [ABSTRACT FROM AUTHOR]

Objective: Postoperative atrial fibrillation is the most commonly observed arrythmia following cardiac surgery. Both atrial fibrillation and preoperative anemia hve been related to high rate of mortality and postoperative morbidity. In this systematic review and meta-analysis, we aimed to analyze whether levels of preoperative hemoglobin or hematocrit were useful biomarkers for development of postoperative atrial fibrillation after cardiac surgery or not. Methodology: The literature screening was performed from PubMed database without any date limitation. All patients who underwent open cardiac surgery procedures were considered. Outcome measures included the association between preoperative levels of hemoglobin/hematocrit and atrial fibrillation after cardiac surgery. The results of trials were evaluated with random or fixed effect model according to the heterogeniety. The statistical evaluation was performed by using Open Meta Analyst programme. Results: A total of 9948 articles were found after database searching. 17 articles were included in metaanalysis consisting of 5934 patients who fulfilled inclusion criteria. The rate of postoperative atrial fibrillation was 35.6% (2114 cases out of 5934). Effect size was observed as heterogenous for studies including hematocrit (Q(df): 30.76, p <0.001, I2: 73.99%). However, it was not observed as heterogeneous for studies including hemoglobin (Q(df): 11.10, p: 0.26, I2:18.96%). Analysis results of studies including hematocrit according to random effect model were SMD: 0.013, 95% CI -0.21-0.18 and p: 0.89 (p >0.05). And analysis results of studies including hemoglobin according to fixed effect model were SMD: 0.172, 95% CI -0.23- -0.11 and p <0.001. Conclusion: The results of quantitative analysis showed that preoperative hemoglobin is associated with development of atrial fibrillation, but hematocrit is not. However, more studies may be required including both hemoglobin and hematocrit in the same trials to clearly establish this association. [ABSTRACT FROM AUTHOR]

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Atrial fibrillation (AF) is the most prevalent arrhythmia in medical practice, as well as the most frequent complication after cardiac surgery: incidence of 40%. AF has been implicated in a prolonged hospitalization, hemodynamic instability and increasing death. Considering that, in the State of Rio Grande do Norte, there's no data collection involving post-operative AF (POAF) occurrence in cardiac surgery, an accurate investigation can contribute to prevent its occurrence and reduce its prevalence. The goal of this study is to determine the incidence of POAF after cardiac surgery in patients previously in sinus rhythm. Moreover, it's intended to identify the clinical and laboratory profile of POAF patients, including their evolution within the hospital. A cross-sectional observational retrospective study, involving 223 patients undergoing cardiac surgery at Onofre Lopes Universitary Hospital (HUOL) from the year 2006 to 2010. The average age of the 223 patients was 58.9±14.6 years, predominantly male (61.4%). The POAF incidence was 13.9% (N=31). Coronary Artery Bypass Graft was the most commonly surgery performed (69.95%), followed by aortic valve replacement (8.52%) and mitral valve replacement (6.27%). POAF patients spent longer in intensive care unit (ICU), median of 4 days. On the other hand, non-POAF patients spent the median of 3 days (p=0.034). Mortality in POAF patients was higher (16.13%) comparing with non-POAF group (9.38%) (p=0,001). The incidence of POAF in cardiac surgery of HUOL was lower than that reported in the literature. However, it was associated with increased length of stay in ICU and death in the hospital course. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Concomitant left atrial appendage occlusion (LAAO) during surgical ablation has emerged as a potential treatment strategy to reduce stroke and perioperative mortality in patients with atrial fibrillation (AF). The present meta-analysis aims to assess current evidence on the efficacy and safety between LAAO and LAA preservation cohorts for patients undergoing cardiac surgery. METHODS: Electronic searches were performed using six electronic databases from their inception to November 2013, identifying all relevant comparative randomized and observational studies comparing LAAO with non-LAAO in AF patients undergoing cardiac surgery. Data were extracted and analysed according to predefined endpoints including mortality, stroke, postoperative AF and reoperation for bleeding. RESULTS: Seven relevant studies identified for qualitative and quantitative analyses, including 3653 patients undergoing LAAO (n = 1716) versus non-LAAO (n = 1937). Stroke incidence was significantly reduced in the LAAO occlusion group at the 30-day follow-up [0.95 vs 1.9%; odds ratio (OR) 0.46; P = 0.005] and the latest follow-up (1.4 vs 4.1%; OR 0.48; P = 0.01), compared with the non-LAAO group. Incidence of all-cause mortality was significantly decreased with LAAO (1.9 vs 5%; OR 0.38; P = 0.0003), while postoperative AF and reoperation for bleeding was comparable. CONCLUSIONS: While acknowledging the limitations and inadequate statistical power of the available evidence, this study suggests LAAO as a promising strategy for stroke reduction perioperatively and at the short-term follow-up without a significant increase in complications. Larger randomized studies in the future are required, with clearer surgical and anticoagulation protocols and adequate long-term followup, to validate the clinical efficacy of LAAO versus non-LAAO groups. [ABSTRACT FROM AUTHOR]

Introduction: Atrial fibrillation (AF) has an incidence rate of approximately 30% and is the most frequent arrhythmia following heart surgery. Factors such as inflammation, the presence of heart fibrosis, stress and cardiomyocyte apoptosis, have all been associated with AF. Objectives: We believe that atrial remodelling is a pre-existent process in patients with postsurgical AF. We have analyzed the factors related to the incidence of atrial fibrillation in the period after heart surgery. Methods: We included consecutive, hemodynamically stable patients with a sinusal rhythm who were subjected to programmed heart surgery with extracorporeal circulation. An assessment was made of the fall in atrial fibrillation after surgery using prolonged electrocardiographic monitoring. Results: A total of 100 patients were included in the study and were subjected to either coronary revascularisation surgery (59) or aortic valve substitution due to severe aortic stenosis (41). Postoperative AF occurred in 29 patients who received predominantly more valve surgery than coronary surgery. The following factors were predictive of postoperative AF in the multivariate analysis: Male sex; beta-blocker therapy for chronic disease; the use of intraoperative; fibrinogen perfusion; low HDL cholesterol values; and high sensitive troponin T values, in the preoperative period. Conclusions: HDL cholesterol and high sensitive troponin T can be useful biomarkers to predict the occurrence of AF after surgery. The early identification of these patients who develop of FA allows us to take preventive measures to minimize the negative effects. [ABSTRACT FROM AUTHOR]

Background Postoperative atrial fibrillation (AF) is a common complication after cardiac surgery. Inflammation is believed to play a pivotal role in the etiology of postoperative AF. There is a suggestion from small studies that perioperative treatment with corticosteroids may reduce postoperative AF. The DExamethasone for Cardiac Surgery (DECS) study was a large randomized trial showing no protective effect of dexamethasone on major adverse events. The aim of this study was to investigate the effect of dexamethasone treatment on the occurrence of AF after cardiac surgery. Methods The DECS study compared intra-operative dexamethasone (1 mg/kg) or placebo treatment in 4494 adult patients undergoing cardiac surgery. AF was defined by the occurrence of any reported AF within 30 days after surgery. We also performed an in-depth analysis of a subset of 1565 patients on new-onset AF. Relative risks (RRs) with 95% confidence intervals (CIs) were calculated. Results The incidence of any AF in the main study of 4494 patients was 33.1% in the dexamethasone and 35.2% in the placebo group (RR 0.94, 95% CI: 0.87-1.02, p = 0.14). In the substudy of 1565 patients, the incidence of new-onset AF was 33.0% vs. 35.5% (RR 0.93, 95% CI: 0.81-1.07, p = 0.31), respectively. There was no protective effect of dexamethasone across clinically important patient subgroups. Conclusion Intraoperative administration of dexamethasone had no protective effect on the occurrence of any or new-onset atrial fibrillation after cardiac surgery. Therefore, the use of dexamethasone for the reduction of postoperative AF should not be recommended. [ABSTRACT FROM AUTHOR]

Postoperative atrial fibrillation ( POAF) is the most common complication following cardiac surgery, occurring in up to 65% of cardiac surgical patients. It is a condition associated with increased morbidity, increased length of hospital stay, and increased health care costs. One of the many potential causes of POAF is postsurgical inflammation, as demonstrated by increased levels of inflammatory biomarkers such as C-reactive protein and interleukin-6. Although still a subject of debate, the role of these inflammatory markers in the pathogenesis of POAF remains under vigorous investigation. Several antiinflammatory drugs have demonstrated promising results in prevention of POAF, including nonsteroidal antiinflammatory drugs, glucocorticoids, and statins. Colchicine is one of the oldest medications used in modern medicine, typically for the treatment and prevention of gout. New evidence has recently surfaced that colchicine may also be useful in the prevention of POAF. In recent studies, colchicine has demonstrated both safety and efficacy in the prevention of POAF. Several new studies are currently being initiated that may further elucidate colchicine's role in the prevention of POAF. [ABSTRACT FROM AUTHOR]

IMPORTANCE Postpericardiotomy syndrome, postoperative atrial fibrillation (AF), and postoperative effusions may be responsible for increased morbidity and health care costs after cardiac surgery. Postoperative use of colchicine prevented these complications in a single trial. OBJECTIVE To determine the efficacy and safety of perioperative use of oral colchicine in reducing postpericardiotomy syndrome, postoperative AF, and postoperative pericardial or pleural effusions. DESIGN, SETTING, AND PARTICIPANTS Investigator-initiated, double-blind, placebo-controlled, randomized clinical trial among 360 consecutive candidates for cardiac surgery enrolled in 11 Italian centers between March 2012 and March 2014. At enrollment, mean age of the trial participants was 67.5 years (SD, 10.6 years), 69% were men, and 36% had planned valvular surgery. Main exclusion criteria were absence of sinus rhythm at enrollment, cardiac transplantation, and contraindications to colchicine. INTERVENTIONS Patients were randomized to receive placebo (n=180) or colchicine (0.5 mg twice daily in patients ≥70 kg or 0.5 mg once daily in patients <70 kg; n=180) starting between 48 and 72 hours before surgery and continued for 1 month after surgery. MAIN OUTCOMES AND MEASURES Occurrence of postpericardiotomy syndrome within 3 months; main secondary study end points were postoperative AF and pericardial or pleural effusion. RESULTS The primary end point of postpericardiotomy syndrome occurred in 35 patients (19.4%) assigned to colchicine and in 53 (29.4%) assigned to placebo (absolute difference, 10.0%; 95% Cl, 1.1%-18.7%; number needed to treat = 10). There were no significant differences between the colchicine and placebo groups for the secondary end points of postoperative AF (colchicine, 61 patients [33.9%]; placebo, 75 patients [41.7%]; absolute difference, 7.8%; 95% Cl, -2.2% to 17.6%) or postoperative pericardial/pleural effusion (colchicine, 103 patients [57.2%]; placebo, 106 patients [58.9%]; absolute difference, 1.7%; 95% Cl, -8.5% to 11.7%), although there was a reduction in postoperative AF in the prespecified on-treatment analysis (placebo, 61/148 patients [41.2%]; colchicine, 38/141 patients [27.0%]; absolute difference, 14.2%; 95% Cl, 3.3%-24.7%). Adverse events occurred in 21 patients (11.7%) in the placebo group vs 36 (20.0%) in the colchicine group (absolute difference, 8.3%; 95% Cl; 0.76%-15.9%; number needed to harm = 12), but discontinuation rates were similar. No serious adverse events were observed. CONCLUSIONS AND RELEVANCE Among patients undergoing cardiac surgery, perioperative use of colchicine compared with placebo reduced the incidence of postpericardiotomy syndrome but not of postoperative AF or postoperative pericardial/pleural effusion. The increased risk of gastrointestinal adverse effects reduced the potential benefits of colchicine in this setting. [ABSTRACT FROM AUTHOR]

IMPORTANCE Clinically apparent atrial fibrillation increases the risk of ischemic stroke. In contrast, perioperative atrial fibrillation may be viewed as a transient response to physiological stress, and the long-term risk of stroke after perioperative atrial fibrillation is unclear. OBJECTIVE To examine the association between perioperative atrial fibrillation and the long-term risk of stroke. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study using administrative claims data on patients hospitalized for surgery (as defined by surgical diagnosis related group codes), and discharged alive and free of documented cerebrovascular disease or preexisting atrial fibrillation from nonfederal California acute care hospitals between 2007 and 2011. Patients undergoing cardiac vs other types of surgery were analyzed separately. MAIN OUTCOMES AND MEASURES Previously validated diagnosis codes were used to identify ischemic strokes after discharge from the index hospitalization for surgery. The primary predictor variable was atrial fibrillation newly diagnosed during the index hospitalization, as defined by previously validated present-on-admission codes. Patients were censored at postdischarge emergency department encounters or hospitalizations with a recorded diagnosis of atrial fibrillation. RESULTS Of 1 729 360 eligible patients, 24 711 (1.43%; 95% CI, 1.41%-1.45%) had new-onset perioperative atrial fibrillation during the index hospitalization and 13 952 (0.81%; 95% CI, 0.79%-0.82%) experienced a stroke after discharge. In a Cox proportional hazards analysis accounting for potential confounders, perioperative atrial fibrillation was associated with subsequent stroke both after noncardiac and cardiac surgery. Cumulative Rate of Stroke 1 Year After Hospitalization, % (95% CI) Type of Surgery Perioperative Atrial Fibrillation No Perioperative Atrial Fibrillation Hazard Ratio (95% CI) Noncardiac 1.47 (1.24-1.75) 0.36 (0.35-0.37) 2.0 (1.7-2.3) Cardiac 0.99 (0.81-1.20) 0.83 (0.76-0.91) 1.3 (1.1-1.6) The association with stroke was significantly stronger for perioperative atrial fibrillation after noncardiac vs cardiac surgery (P < .001 for interaction). CONCLUSIONS AND RELEVANCE Among patients hospitalized for surgery, perioperative atrial fibrillation was associated with an increased long-term risk of ischemic stroke, especially following noncardiac surgery. [ABSTRACT FROM AUTHOR]

Aims and Objectives: Postoperative atrial fibrillation (POAF) is the most common arrhythmia after coronary artery bypass grafting (CABG) surgery. The identification of patients at r isk for POAF would be helpful to guide prophylactic therapy. Presently, there is no simple preoperative scoring system available to predict patients at higher risk of POAF. In a retrospective observational study, we evaluated the usefulness of CHA2DS2-VASc score to predict POAF after CABG. Materials and Methods: After obtaining approval from Institutional Review Board, 729 patients undergoing CABG on cardiopulmonary bypass (CPB) were enrolled. Patients were followed in the postoperative period for POAF. A multiple regression analysis was run to predict POAF from various variables. The area under the receiver operating characteristic (ROC) curve was calculated to test discriminatory power of CHA2DS2-VASc score to predict POAF. Results: POAF occurred in 95 (13%) patients. The patients with POAF had higher CHA2DS2-VASc scores than those without POAF (4.09 ± 0.90 vs. 2.31 ± 1.21; P < 0.001). The POAF rates after cardiac surgery increased with increasing CHA2DS2-VASc scores. The odds ratio for predicting POAF was highest with higher CHA2DS2-VASc scores (3.68). When ROC curve was calculated for the CHA2DS2-VASc scores, area of 0.87 was obtained, which was statistically significant (P < 0.0001). Conclusions: The CHA2DS2-VASc score was found useful in predicting POAF after CABG. This scoring system is simple and convenient to use in the preoperative period to alert the clinician about higher probability of POAF after CABG surgery. [ABSTRACT FROM AUTHOR]

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. Design MEDLINE, EMBASE and the Cochrane Central Register were systematically reviewed by two independent investigators for studies published between January 1980 and May 2012, in which an association between serum markers of inflammation and PNAF was evaluated, or the effect of drugs with anti-inflammatory properties on the risk of PNAF. Results Sixty-three studies met selection criteria (39 observational and 24 randomized studies) including 27 363 patients. The mean incidence of PNAF after cardiac surgery was 25·5%. Elevated levels of various inflammatory mediators were associated with PNAF, and the most consistent association was found between white blood cell count and PNAF. Of the drugs with anti-inflammatory properties, statins gave the best protective effect against PNAF, followed by anti-oxidants, steroids and colchicine. Nonsteroidal anti-inflammatory drugs did not prevent PNAF significantly. Conclusion The postoperative inflammation response may play a role in the pathogenesis of PNAF. However, of the inflammation biomarkers, only elevated white blood cell count reliably predicts PNAF. Pre- and perioperative use of statins and several other drugs with anti-inflammatory properties reduce the incidence of PNAF. [ABSTRACT FROM AUTHOR]

Objectives. To investigate the association between postoperative atrial fibrillation (POAF) and cause-specific death after coronary artery bypass grafting (CABG) over time. Design. The cohort included 6821 patients undergoing primary isolated CABG between 1996 and 2009. Survival analyses using Cox proportional hazards determined the association between POAF and late mortality and cause of death. Four categories of mortality were examined: cardiac mortality; and death related to arrhythmia, cerebrovascular disease, and heart failure. Results. Median follow-up was 9.8 years and 2152 of 6821 patients (32%) developed POAF. During follow-up, 2302 of 6821 patients (34%) died. For all mortality categories, lower survival rates were found among POAF patients. After adjustment for baseline characteristics, medical history, and preoperative status, POAF was related to increased mortality in all four categories: cardiac mortality (HR 1.4; 95% CI 1.3-1.5); death related to arrhythmia (HR 1.8; 95% CI 1.6-2.0); cerebrovascular disease (HR 1.4; 95% CI 1.2-1.6); and heart failure (HR 1.4; 95% CI 1.3-1.6). The effect remained more than 8 years after surgery. Conclusions. POAF predicts cause-specific late mortality after CABG, with a sustained effect many years postoperatively. This suggests that POAF-episodes are not merely an indication of more advanced disease at surgery, but predicts a persistent negative effect on cause-specific survival. [ABSTRACT FROM AUTHOR]

OBJECTIVES Postoperative atrial fibrillation (AFib) is common in patients undergoing coronary artery bypass grafting. Little information is available concerning AFib following minimally invasive cardiac surgery. The aim of our study was to assess the incidence of AFib after totally endoscopic coronary artery bypass (TECAB) grafting and to investigate the factors influencing its occurrence. METHODS Between 2001 and 2010, we performed TECAB in 384 patients, 73% male, aged 60 (37–90) years. Single-vessel bypasses were performed in 280 patients, and 104 received multivessel coronary revascularization. Procedures were performed on the beating heart in 80 cases, and 164 patients underwent a hybrid intervention. RESULTS A total of 59 patients (15.4%) developed AFib after TECAB. Univariate analysis showed hypertension (P = 0.005), increased age (P = 0.007), body weight (P = 0.006), body mass index (P = 0.005), EuroSCORE (P = 0.035) and total TECAB operation time (P = 0.01) to be significantly associated with AFib. We also found an increased incidence of AFib in patients undergoing hybrid interventions (P = 0.036) and beating heart TECAB (P = 0.003). Age (P < 0.001) and higher body weight (P = 0.003) were the only predictors found to be significant in multivariate analysis. Hospital mortality was 1.7% (1 of 59) in the group of patients with AFib and 0.6% (2 of 325) in the group that showed no AFib after operation (P = n.s.). Hospital stay was 7 (4–54) days in patients with AFib and 6 (2–33) days in those without AFib (P = n.s.). There was no significant 5-year survival difference in patients with and without postoperative AFib (94 vs 94%, P = n.s.). CONCLUSIONS We conclude that the incidence of postoperative AFib in TECAB is relatively low. Age and body weight are the most important predictors of postoperative AFib following TECAB. Short-term clinical outcome and intermediate-term survival are similar in patients with and without postoperative AFib. [ABSTRACT FROM PUBLISHER]

BACKGROUND/OBJECTIVES: Randomised controlled trials (RCTs) evaluating the effect of fish oil supplementation on postoperative atrial fibrillation (POAF) following cardiac surgery have produced mixed results. In this study, we examined relationships between levels of red blood cell (RBC) n-3 long-chain polyunsaturated fatty acids (LC-PUFAs) and the incidence of POAF. SUBJECTS/METHODS: We used combined data (n=355) from RCTs conducted in Australia and Iceland. The primary end point was defined as POAF lasting >10 min in the first 6 days following surgery. The odds ratios (ORs) for POAF were compared between quintiles of preoperative RBC n-3 LC-PUFA levels by multivariable logistic regression. RESULTS: Subjects with RBC docosahexaenoic acid (DHA) in the fourth quintile, comprising a RBC DHA range of 7.0–7.9%, had the lowest incidence of POAF. Subjects in the lowest and highest quintiles had significantly higher risk of developing POAF compared with those in the fourth quintile (OR=2.36: 95% CI; 1.07–5.24 and OR=2.45: 95% CI; 1.16–5.17, respectively). There was no association between RBC eicosapentaenoic acid levels and POAF incidence. CONCLUSIONS: The results suggest a ‘U-shaped’ relationship between RBC DHA levels and POAF incidence. The possibility of increased risk of POAF at high levels of DHA suggests an upper limit for n-3 LC-PUFAs in certain conditions. [ABSTRACT FROM AUTHOR]

Background--Atrial fibrillation ablation has made tremendous progress with respect to innovation, efficacy, and safety. However, limited data exist regarding the burden and trends in adverse outcomes arising from this procedure. The aim of our study was to examine the frequency of adverse events attributable to atrial fibrillation (AF) ablation and the influence of operator and hospital volume on outcomes. Methods and Results--With the use of the Nationwide Inpatient Sample, we identified AF patients treated with catheter ablation. We investigated common complications including cardiac perforation and tamponade, pneumothorax, stroke, transient ischemic attack, vascular access complications (hemorrhage/hematoma, vascular complications requiring surgical repair, and accidental arterial puncture), and in-hospital death described with AF ablation, and we defined these complications by using validated International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. An estimated 93801 AF ablations were performed from 2000 to 2010. The overall frequency of complications was 6.29% with combined cardiac complications (2.54%) being the most frequent. Cardiac complications were followed by vascular complications (1.53%), respiratory complications (1.3%), and neurological complications (1.02%). The in-hospital mortality was 0.46%. Annual operator (<25 procedures) and hospital volume (<50 procedures) were significantly associated with adverse outcomes. There was a small (nonsignificant) rise in overall complication rates. Conclusions--The overall complication rate was 6.29% in patients undergoing AF ablation. There was a significant association between operator and hospital volume and adverse outcomes. This suggests a need for future research into identifying the safety measures in AF ablations and instituting appropriate interventions to improve overall AF ablation outcomes. [ABSTRACT FROM AUTHOR]

Objectives: This study sought to provide bedside evidence of the potential link between cardiac mitochondrial dysfunction and arrhythmia as reported in bench studies. Background: Atrial fibrillation (AF) is a frequent complication of cardiac surgery. Underlying mechanisms of post-operative atrial fibrillation (POAF) remain largely unknown. Because cardiac mitochondrial dysfunction has been reported in clinical conditions with a high risk of POAF, we investigated whether a causal link exists between POAF onset and pre-operative function of cardiac mitochondria. Methods: Pre-operative mitochondrial respiration and calcium retention capacity, respiratory complex activity, and myocardial oxidative stress were quantified in right atrial tissue from 104 consecutive patients with metabolic syndrome, in sinus rhythm, and undergoing coronary artery bypass graft surgery. Results: In this high-risk population, POAF occurred in 44% of patients. Decreased pre-operative mitochondrial respiration and increased sensitivity to calcium-induced mitochondrial permeability transition pore opening were significantly associated with POAF. Adenosine diphosphate–stimulated mitochondrial respiration supported by palmitoyl-l-carnitine was significantly lower in POAF patients and remained independently associated with AF onset after adjustment for age, body mass index, heart rate, beta-blocker use, and statin medication (multivariate logistic regression coefficient per unit = −0.314 ± 0.144; p = 0.028). Gene expression profile analysis identified a general downregulation of the mitochondria/oxidative phosphorylation gene cluster in pre-operative atrial tissue of patients in whom AF developed. Conclusions: Our prospective study identifies an association between pre-operative mitochondrial dysfunction of the atrial myocardium and AF occurrence after cardiac surgery in patients with metabolic disease, providing novel insights into the link between mitochondria and arrhythmias in patients. [ABSTRACT FROM AUTHOR]

Patients with mechanical "hardware" in the heart, such as those with mechanical cardiac valves or atrial septal closure devices, represent a population at high risk of developing AF. Catheter ablation of AF in these subjects might represent a challenge, due to the perceived higher risk of complications associated with the presence of intracardiac mechanical devices. Accordingly, such patients were excluded or poorly represented in major trials proving the benefit of catheter ablation for the rhythm-control of AF. However, recent evidence supports the concept that catheter ablation procedures might be equally effective in these patients, without a significant increase in the risk of procedural complications. This review will summarize the current state-of-the-art on catheter ablation of AF in patients with mechanical "hardware" in the heart. [ABSTRACT FROM AUTHOR]

Background and aim: We sought to evaluate the long-term impact of post-cardiac surgery atrial fibrillation on the risk of stroke and survival. Methods: Patients undergoing isolated CABG surgery from April 1, 1995 to March 31, 2007 were identified ( n = 8058). Long-term stroke data were compiled using Cox modeling adjusted for clinical characteristics comparing patients with new-onset atrial fibrillation (NwAfib) and those without. Results: NwAfib developed in 2214 patients (27.5%). Overall in-hospital mortality was 2.4% and was not different between groups. Unadjusted in-hospital outcomes suggest patients with NwAfib were more likely to suffer a permanent stroke (1% vs 2.5%; p < 0.001) require prolonged mechanical ventilation ( p < 0.001) and prolonged stay in hospital ( p < 0.001). After discharge patients were followed for a mean of 5.7 years. Stroke was reported in 268 (12.1%) patients in the NwAfib group compared to others (8.4%). After adjustment NwAfib was independently associated with a higher risk for stroke with a hazard ratio of 1.26 (1.08-1.47; p = 0.0034) and a higher risk of death with a hazard ratio of 1.2 (1.08-1.32; p = 0.0007). Conclusions: Patients with NwAfib perioperatively have increased risk of stroke and early death after discharge independent of other clinical risk factors. [ABSTRACT FROM AUTHOR]

Background: Octogenarians are a challenging group of patients referred for cardiac surgery. The aim of this study is to assess early outcomes of coronary artery bypass grafting (CABG) performed in the elderly population. Methods: We performed a meta-analysis of all published observational studies comparing early results of conventional CABG surgery and off-pump CABG surgery in patients aged 80 years or older. The outcomes of interest were mortality, stroke, respiratory failure, renal failure, incidence of support with intraaortic balloon pump, and incidence of postoperative atrial fibrillation. The random effects model was used. Results: Fourteen studies were analyzed. The total number of included subjects was 4,991, of whom 3,113 underwent conventional CABG surgery (62.4%), and 1,878 (37.6%) underwent off-pump CABG surgery. The rates of mortality, stroke, and respiratory failure were significantly higher in the conventional CABG surgery group. Conclusions: These results confirm that off-pump CABG surgery remains a valuable option of surgical myocardial revascularization, and may optimize the outcome in senior patients. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to evaluate the role of the myocardial redox state in the development of in-hospital complications after cardiac surgery and the effect of statins on the myocardial redox state. Background: Statins improve clinical outcome after cardiac surgery, but it is unclear whether they exert their effects by modifying the myocardial redox state. Methods: We quantified myocardial superoxide anion (O2 −) and peroxynitrite (ONOO−) and their enzymatic sources in samples of the right atrial appendage (RAA) from 303 patients undergoing cardiac surgery who were followed up until discharge, and in 42 patients who were randomized to receive 3-day treatment with atorvastatin 40 mg/d or placebo before surgery. The mechanisms by which atorvastatin modifies myocardial redox state were investigated in 26 RAA samples that were exposed to atorvastatin ex vivo. Results: Atrial O2 − (derived mainly from nicotinamide adenine dinucleotide phosphate [NADPH] oxidases) and ONOO− were independently associated with increased risk of atrial fibrillation, the need for post-operative inotropic support, and the length of hospital stay. Pre-operative atorvastatin treatment suppressed atrial NADPH oxidase activity and myocardial O2 − and ONOO− production. Ex vivo incubation of RAA samples with atorvastatin induced a mevalonate-reversible and Rac1-mediated inhibition of NADPH oxidase. Conclusions: There is a strong independent association between myocardial O2 −/ONOO− and in-hospital complications after cardiac surgery. Both myocardial O2 − and ONOO− are reduced by pre-operative statin treatment, through a Rac1-mediated suppression of NADPH oxidase activity. These findings suggest that inhibition of myocardial NADPH oxidases may contribute to the beneficial effect of statins in patients undergoing cardiac surgery. (Effects of Atorvastatin on Endothelial Function, Vascular and Myocardial Redox State in High Cardiovascular Risk Patients; NCT01013103) [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is the most common arrhythmia after cardiac surgery. The peak of incidence occurs between the second and third postoperative day. Postoperative AF is a risk factor for stroke, congestive heart failure and hemodynamic instability that increases the morbidity and mortality particularly, in elderly patients with left ventricular dysfunction. AF has been associated with prolonged hospitalization and increased costs. The etiology of this arrhythmia are not yet fully understood. This article reviews what is currently known about the pathophysiological mechanisms that trigger AF after cardiac surgery. The risk factors for postoperative AF in cardiac surgery are also revised. Additionally, recommendations are made on the management of patients with AF which include: control of heart rate and cardiac rhythm, the combined use of antiplatelet and anticoagulant therapy and use of antiarrhythmic drugs. Beta blockers can effectively prevent this arrhythmia so they are widely recommended if there is no contraindication. Sotalol may be the most effective of beta blockers. Amiodarone is useful when beta-blocker therapy is not possible or as additional prophylaxis in high risk patients. The use of other agents such as magnesium, calcium channels blockers, non-steroidal anti-inflammatory drugs, corticosteroids, and statins are mentioned. Finally, we include a protocol for postoperative AF management based on the most recent guidelines. [ABSTRACT FROM AUTHOR]

Background--Inflammation and pericarditis may be contributing factors for postoperative atrial fibrillation (POAF), and both are potentially affected by antiinflammatory drugs and colchicine, which has been shown to be safe and efficacious for the prevention of pericarditis and the postpericardiotomy syndrome (PPS). The aim of the Colchicine for the Prevention of the Post-Pericardiotomy Syndrome (COPPS) POAF substudy was to test the efficacy and safety of colchicine for the prevention of POAF after cardiac surgery. Methods and Results--The COPPS POAF substudy included 336 patients (mean age, 65.7±12.3 years; 69% male) of the COPPS trial, a multicenter, double-blind, randomized trial. Substudy patients were in sinus rhythm before starting the intervention (placebo/colchicine 1.0 mg twice daily starting on postoperative day 3 followed by a maintenance dose of 0.5 mg twice daily for 1 month in patients ≥70 kg, halved doses for patients <70 kg or intolerant to the highest dose). The substudy primary end point was the incidence of POAF on intervention at 1 month. Despite well-balanced baseline characteristics, patients on colchicine had a reduced incidence of POAF (12.0% versus 22.0%, respectively; P=0.021; relative risk reduction, 45%; number needed to treat, 11) with a shorter in-hospital stay (9.4±3.7 versus 10.3±4.3 days; P=O.040) and rehabilitation stay (12.1 ±6.1 versus 13.9±6.5 days; P=0.009). Side effects were similar in the study groups. Conclusion--Colchicine seems safe and efficacious in the reduction of POAF with the potentiality of halving the complication and reducing the hospital stay. [ABSTRACT FROM AUTHOR]

Background Postoperative atrial fibrillation (POAF) affects approximately 30% of patients undergoing elective cardiac surgery. While its pathogenesis is multifactorial, increasing evidence supports a role for oxidative stress in the electrophysiological remodelling associated with AF. Although prophylactic antioxidants appear to be a potentially attractive pharmacotherapy, there is still uncertainty regarding their efficacy. This study aims to provide a quantitative summary of the current evidence surrounding antioxidant vitamins and POAF prevention. Methods A systematic literature review identified five randomised controlled trials incorporating 567 patients (n=284 antioxidant, n=283 control). These were metaanalysed using random effects modelling. Heterogeneity, subgroup analysis, quality scoring and risk of bias were assessed. Primary endpoints were the incidence of POAF and all-cause arrhythmia. Secondary endpoints were length of stay in the intensive care unit (ITU) and length of hospital stay. Results Vitamins C and E significantly reduced the incidence of POAF (OR 0.43, 95% CI 0.21 to 0.89) and all-cause arrhythmia (OR 0.54, 95% CI 0.29 to 0.99) compared with controls. A significant reduction in both ITU stay (weighted mean difference (WMD) -0.44, 95% CI -0.70 to -0.17) and hospital stay (WMD -1.11, 95% CI -1.70 to -0.52) was also seen in the antioxidant group, without significant heterogeneity. Conclusions The prophylactic use of vitamins C and E may significantly reduce the incidence of POAF and all-cause arrhythmia following cardiac surgery. However, the overall quality of current studies is poor and further research should focus on adequately powered randomised controlled trials that standardise AF reporting, antioxidant protocol and the use of concomitant agents. Cost analysis should be considered to establish the potential economic benefit of antioxidant vitamin prophylaxis in POAF. [ABSTRACT FROM AUTHOR]

Postoperative atrial fibrillation is the most common complication of cardiac surgery. It is associated with increased complication rates. Recent trials have suggested that inflammation and oxidative stress have key roles in the pathophysiology of atrial fibrillation. Current evidence evaluating the use of antiinflammatory and antioxidant agents, including statins, corticosteroids, N-acetylcysteine, vitamin C, and fish oil, to prevent postoperative atrial fibrillation is promising. However, larger randomized, controlled trials comparing different dose regimens are needed. [ABSTRACT FROM AUTHOR]

Background: Approximately 10% to 15% of patients undergoing cardiac operations suffer from atrial fibrillation (AF) at the time of surgery. The current risk stratification methods do not include preoperative arrhythmias. The aim of this study was to assess the effect of preoperative AF on the immediate postoperative outcome of patients undergoing cardiac surgery as well as in the midterm and long-term outcomes. Methods: We reviewed patient data for our institution for a 10-year period; a total of 14,320 patients undergoing any cardiac operation were included; 12,395 (86.5%) had sinus rhythm preoperatively and 1,925 (13.5%) were in persistent AF. After propensity matching and adjusting for the preoperative and operative characteristics, 1,800 patients remained in each group and were compared. Results: Before and after adjusting for the preoperative and operative characteristics, inotropic support, ventilation time, renal failure, stroke, and surgical wound infection rates were all significantly higher for the patients with AF (p < 0.001). Intensive care unit stay and hospital stay as well as in-hospital mortality were also significantly higher among the patients with AF compared with the sinus rhythm group (p < 0.001). At 30 days, 5-year and 10-year mortality rates in the AF group were significantly higher compared with those in sinus rhythm group (p < 0.001). Conclusions: Atrial fibrillation preoperatively is associated with a higher incidence of postoperative complications. This arrhythmia is an important variable that appears to have been excluded from the current risk stratification systems. Our experience suggests that AF should be considered in the development/update of risk-stratifying methodologies to improve the predictive accuracy. [ABSTRACT FROM AUTHOR]

In the general population, African Americans experience atrial fibrillation (AF) less frequently than European Americans. This difference could also exist in the incidence of this arrhythmia after cardiac surgery, but this possibility has been insufficiently examined. To test the association of such an ethnic difference, we compared the incidence of postoperative AF in a consecutive series of 2,312 African Americans and 6,054 European Americans who underwent isolated coronary artery bypass grafting from July 2000 to June 2007. Raw differences between the cohorts in the incidence of new AF were adjusted to take into account the baseline differences. Postoperatively, new-onset AF developed in 504 (22%) of 2,312 African-American patients and in 1,838 (30%) of 6,054 European-American patients (p <0.01). After adjustment with logistic regression analysis for numerous baseline differences, African Americans remained less likely to develop AF (odds ratio 0.63, 95% confidence interval 0.55 to 0.72; p <0.001). Risk was also adjusted using propensity matching. In that analysis, 457 (22%) of 2,059 African-American patients had postoperative AF, as did 597 (29%) of 2,059 matched European-American patients (p <0.01). In conclusion, AF was significantly less common among African-American patients than among European-American patients after coronary artery bypass grafting. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery with extracorporeal circulation. Is associated with increased morbidity and health costs. The ischemia-reperfusion event secondary to extracorporeal circulation leads to inflammation, causing myocardial damage. OBJECTIVE: The aim of this study is to determine the predictive power of high sensitivity C-reactive protein (hsCRP) in POAF. HYPOTHESIS: hsCPR predicts POAF occurrence. MATERIAL AND METHOD: An observational, analytical study, included 123 patients undergoing cardiac surgery with extracorporeal circulation at Universidad de Chile's Hospital, between 2007 and 2010. Continuous electrocardiographic monitoring was performed and plasma hsCPR measurement before surgery, 8 hours postoperatively and at discharge. We performed a multivariate regression analysis considering the known risk factors for POAF and the hsCRP. For continuous quantitative variable ANOVA-Bonferroni was used. Kaplan-Meier analysis of quartiles of hsPCR was used and Mantel-Cox log-rank test for trend test. Receiver operator curve (ROC) was performed to determine the predictive power of the hsPCR. Significance: p<0.05. RESULTS: We describe the clinical and epidemiological characteristics of patients undergoing cardiac surgery. The hsCPR was highest at 8 postoperative hours (ANOVA-Bonferroni p<0.01). The multivariate regression analysis significantly correlated with the occurrence of hsPCR and POAF (p<0.01). The higher quartile of hsCPR was associated with increased occurrence of POAF (p<0.01). The area under the ROC curve was 0.73. DISCUSSION: The postoperative hsPCR is a valuable predictor of the occurrence of POAF in the context of cardiac surgery with extracorporeal circulation. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to examine whether left atrial (LA) mechanical function, as measured by LA total emptying fraction (TEF), is a predictor for the development of post-operative atrial fibrillation (POAF) following cardiac surgery. Background: POAF is an important and frequent complication of cardiac surgery. LA enlargement has been reported to be a risk factor for POAF, but the relationship between LA mechanical function and POAF is not well understood. We examined the relationship between pre-operative LA function and POAF in patients without a history of atrial fibrillation. Methods: A total of 101 subjects (mean age 64 ± 13 years) underwent pre-operative transthoracic echocardiograms and were followed for occurrence of POAF during the hospitalization for cardiac surgery. The left atrial maximum volume (LAVmax) and left atrial minimum volume (LAVmin) were measured and indexed to body surface area (LAVmaxI and LAVminI, respectively). LA TEF was calculated as: {[(LAVmax – LAVmin)/LAVmax] × 100%}. Univariate and multivariate analyses examined clinical and echocardiographic predictors of POAF. Results: POAF occurred in 41% of subjects. Mean LA TEF was 49 ± 15%, mean LAVmaxI was 38 ± 15 ml/m2, and mean LAVminI was 20 ± 13 ml/m2. Age, LA TEF, and LAVminI were independent predictors of POAF. LA TEF was lower in patients with POAF compared with those without POAF (43 ± 15% vs. 55 ± 13%, p < 0.001), and patients with a LA TEF <50% had a high risk of POAF (odds ratio: 7.94, 95% confidence interval: 3.23 to 19.54, p < 0.001). Compared with LAVmaxI >32 ml/m2, LA TEF <50% had higher discriminatory power for POAF, which remained significantly higher when adjusted for age (p = 0.04). Conclusions: LA TEF is an independent predictor of POAF and is a stronger predictor of POAF than LAVmaxI is. Impaired LA mechanical function may help to identify patients who are most likely to benefit from prophylaxis for POAF. [Copyright &y& Elsevier]

Background: Atrial fibrillation (AF) is an important cause of morbidity and mortality after cardiac surgery. The pathogenesis of AF appears to be multifactorial but little is known about the cause-effect relationship of substrate modifications with the onset of the arrhythmia. With the use of modern proteomics, this study aims to identify preexisting changes in the left atrium of patients susceptible to postoperative AF. Methods: We analyzed 20 matched patients undergoing elective, first-time coronary artery bypass grafting with no history of AF. They were divided into 2 equal groups according to the development of postoperative AF. Proteomic analysis was performed in left atrial tissue obtained during surgery using two-dimensional difference in gel electrophoresis techniques. Mass spectrometry identified proteins that were differentially expressed in patients who developed AF against those who remained in sinus rhythm. Results: Proteomic analysis of left atrial tissue identified 19 differentially expressed protein spots between patients who developed postoperative AF and their sinus rhythm counterparts. In patients who developed AF, proteins associated with oxidative stress and apoptosis (peroxiredoxin 1, apoptosis-inducing factor, and 96S protease regulatory subunit 8) as well as acute phase response components (apolipoprotein A-I, fibrinogen) were found to be increased. Conversely, the expression of proteins responsible for glycolysis (enolase) and pyruvate metabolism (pyruvate dehydrogenase) was reduced. Conclusions: We describe protein changes that precede the development of postoperative AF and which might be suggestive of increased oxidative stress and glycolytic inhibition in the left atrium of patients predilected to AF. [ABSTRACT FROM AUTHOR]

Postoperative atrial fibrillation (POAF), a common complication of cardiac surgery, can increase the morbidity and mortality, as well as the costs of the surgery being preformed. Guidelines recommend the use of β-blockers, amiodarone, or sotalol to decrease the risk of experiencing POAF. However, none of these agents fully protect the patient from POAF, thus newer agents are needed to be used in combination with them. Many different agents have been studied to fit this role and may be grouped into 2 categories: agents with antiarrhythmic activity such as magnesium and polyunsaturated fatty acids and agents with anti-inflammatory activity such as statins and free radical scavengers. Most of these novel agents have been studied in a wide variety of trials; however, some clearly have more effect than others. Although none of these newer agents have the data required to make blanket recommendations for use at this point, given the safety profile and low costs of some, many continue to be evaluated in randomized-controlled trials. [ABSTRACT FROM PUBLISHER]