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Atrial fibrillation after cardiac surgery: where are we now?

Patel D, Gillinov MA, Natale A - Indian Pacing Electrophysiol J (2008)

Bottom Line: POAF is associated with an increased risk of morbidity and mortality, and longer hospital stay.Prophylactic treatments reduce the likelihood of POAF.All other patients should be managed with rate strategies.

View Article: PubMed Central - PubMed

Affiliation: St. David's Medical Center,Austin, TX 78744, USA. dimpi.patel@stdavids.com

ABSTRACT

Objective: To review: 1) Pathophysiology of postoperative atrial fibrillation (POAF); 2) Risk factors for POAF; 3) Prophylaxis of POAF; 4) Treatment of POAF; and 5) Future directions.

Methods: We searched the Medline database for articles published between January, 1966 to September, 2008. We used the following keywords: Atrial fibrillation, Postoperative atrial fibrillation, Coronary Artery Bypass, and antiarrhythmic agents. Additionally, we searched references from all relevant articles.

Conclusions: POAF occurs in 25-60% of patients depending on the type of cardiac surgery performed. POAF generally occurs on postoperative day 2 or 3. POAF is associated with an increased risk of morbidity and mortality, and longer hospital stay. Prophylactic treatments reduce the likelihood of POAF. In patients who experience POAF, rhythm strategies should be used in those who are symptomatic and hemodynamically unstable. All other patients should be managed with rate strategies.

No MeSH data available.


Related in: MedlinePlus

The potential role of inflammation and oxidative stress in atrial fibrillation-induced electrical remodeling.  Ical-L-type Ca2+ current; ADP-action potential duration; AERP-atrial refractory period; CV-conduction velocity.  Reproduced with permission from Korantzopoulos P, Kolettis T, Siogas K, Goudevenos J. Atrial fibrillation and electrical remodeling: the potential role of inflammation and oxidative stress. Reproduced with permission from Med Sci Monit. 2003;9:RA225-9.
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Figure 1: The potential role of inflammation and oxidative stress in atrial fibrillation-induced electrical remodeling. Ical-L-type Ca2+ current; ADP-action potential duration; AERP-atrial refractory period; CV-conduction velocity. Reproduced with permission from Korantzopoulos P, Kolettis T, Siogas K, Goudevenos J. Atrial fibrillation and electrical remodeling: the potential role of inflammation and oxidative stress. Reproduced with permission from Med Sci Monit. 2003;9:RA225-9.

Mentions: The association between AF and inflammation was first observed by Frustaci who demonstrated that the atria of patients with lone AF had a higher prevalence of inflammatory infiltrates, myocyte necrosis, and fibrosis in comparison to patients without AF [8]. Since then, several studies have explored the role of inflammation in AF; however, there is still some debate as to whether inflammation causes AF. Rapid atrial activation causes an accumulation of calcium in atrial myocytes. As a result of the increased levels of intracellular calcium, there is a reduction of the inward L-type Ca2+ current. This results in both a shorter action potential duration and effective refractory period, thereby creating a favorable environment for the initiation and perpetuation of AF. In some cases the Ca2+ can cause cell apoptosis and subsequent inflammatory response and may contribute to structural remodeling and ultimately persistence of AF (Figure 1) [9].


Atrial fibrillation after cardiac surgery: where are we now?

Patel D, Gillinov MA, Natale A - Indian Pacing Electrophysiol J (2008)

The potential role of inflammation and oxidative stress in atrial fibrillation-induced electrical remodeling.  Ical-L-type Ca2+ current; ADP-action potential duration; AERP-atrial refractory period; CV-conduction velocity.  Reproduced with permission from Korantzopoulos P, Kolettis T, Siogas K, Goudevenos J. Atrial fibrillation and electrical remodeling: the potential role of inflammation and oxidative stress. Reproduced with permission from Med Sci Monit. 2003;9:RA225-9.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2572025&req=5

Figure 1: The potential role of inflammation and oxidative stress in atrial fibrillation-induced electrical remodeling. Ical-L-type Ca2+ current; ADP-action potential duration; AERP-atrial refractory period; CV-conduction velocity. Reproduced with permission from Korantzopoulos P, Kolettis T, Siogas K, Goudevenos J. Atrial fibrillation and electrical remodeling: the potential role of inflammation and oxidative stress. Reproduced with permission from Med Sci Monit. 2003;9:RA225-9.
Mentions: The association between AF and inflammation was first observed by Frustaci who demonstrated that the atria of patients with lone AF had a higher prevalence of inflammatory infiltrates, myocyte necrosis, and fibrosis in comparison to patients without AF [8]. Since then, several studies have explored the role of inflammation in AF; however, there is still some debate as to whether inflammation causes AF. Rapid atrial activation causes an accumulation of calcium in atrial myocytes. As a result of the increased levels of intracellular calcium, there is a reduction of the inward L-type Ca2+ current. This results in both a shorter action potential duration and effective refractory period, thereby creating a favorable environment for the initiation and perpetuation of AF. In some cases the Ca2+ can cause cell apoptosis and subsequent inflammatory response and may contribute to structural remodeling and ultimately persistence of AF (Figure 1) [9].

Bottom Line: POAF is associated with an increased risk of morbidity and mortality, and longer hospital stay.Prophylactic treatments reduce the likelihood of POAF.All other patients should be managed with rate strategies.

View Article: PubMed Central - PubMed

Affiliation: St. David's Medical Center,Austin, TX 78744, USA. dimpi.patel@stdavids.com

ABSTRACT

Objective: To review: 1) Pathophysiology of postoperative atrial fibrillation (POAF); 2) Risk factors for POAF; 3) Prophylaxis of POAF; 4) Treatment of POAF; and 5) Future directions.

Methods: We searched the Medline database for articles published between January, 1966 to September, 2008. We used the following keywords: Atrial fibrillation, Postoperative atrial fibrillation, Coronary Artery Bypass, and antiarrhythmic agents. Additionally, we searched references from all relevant articles.

Conclusions: POAF occurs in 25-60% of patients depending on the type of cardiac surgery performed. POAF generally occurs on postoperative day 2 or 3. POAF is associated with an increased risk of morbidity and mortality, and longer hospital stay. Prophylactic treatments reduce the likelihood of POAF. In patients who experience POAF, rhythm strategies should be used in those who are symptomatic and hemodynamically unstable. All other patients should be managed with rate strategies.

No MeSH data available.


Related in: MedlinePlus