FOCUS ISSUE: ATRIAL FIBRILLATION: STATE-OF-THE-ART PAPER
Mechanisms, Prevention, and Treatment of Atrial Fibrillation After Cardiac Surgery
Najmeddine Echahidi, MD*,
Philippe Pibarot, DVM, PhD, FACC, FAHA*,1,
Gilles O’Hara, MD, FACC* and
Patrick Mathieu, MD, FRCSC ,*,2
* Department of Medicine, Laval Hospital Research Center/Quebec Heart Institute, Laval University, Ste-Foy, Quebec, Canada
Department of Surgery, Laval Hospital Research Center/Quebec Heart Institute, Laval University, Ste-Foy, Quebec, Canada.
Manuscript received July 3, 2007;
revised manuscript received September 21, 2007,
accepted October 7, 2007.
* Reprint requests and correspondence: Dr. Patrick Mathieu, Hôpital Laval, 2725 Chemin Ste-Foy, Quebec, Canada, G1V-4G5. (Email: patrick.mathieu{at}chg.ulaval.ca).
Post-operative atrial fibrillation (POAF) is a frequent complication occurring in 30% to 50% of patients after cardiac surgery. It is associated with an increased risk of mortality and morbidity, predisposes patients to a higher risk of stroke, requires additional treatment, and increases the costs of the post-operative care. The aim of this review is to present the current state of knowledge about the risk factors, mechanisms, prevention, and treatment of this complication. In addition to the well known risk factors for the development of POAF such as age, left atrial enlargement, and valvular surgery, new metabolic risk factors related to visceral obesity have been identified. With regard to the prevention of POAF, beta-blocker drugs are effective and safe and can be used in most patients, whereas amiodarone can be added in high-risk patients. Biatrial pacing was shown to be effective; however, its complexity might limit its application. Although there are only few data regarding the usefulness of magnesium, statins, N-3 polyunsaturated fatty acids, and corticosteroids, their addition to beta-blocker drugs might be of benefit for further reducing POAF. Treatment includes the use of an AV nodal blocking agent to achieve the rate control. If AF does not spontaneously convert to sinus rhythm within 24 h, anticoagulation should be initiated and a rhythm control strategy should be attempted. More investigations are warranted to explore mechanisms by which POAF occurs. This new knowledge would undoubtedly translate into a more efficient prevention and treatment of this common post-operative complication that is associated with a major health and economic burden.
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Abbreviations and Acronyms
| | AF = atrial fibrillation | | AV = atrioventricular | | CABG = coronary artery bypass graft | | CI = confidence interval | | HR = hazard ratio | | OR = odds ratio | | POAF = post-operative atrial fibrillation | | PUFAs = N-3 polyunsaturated fatty acids |
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143(2):
451 - 459.e1.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
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2011 ACCF/AHA guideline for coronary artery bypass graft surgery: Executive summary A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.
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January 1, 2012;
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[Full Text]
[PDF]
|
|
|
|
|
|
|
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January 1, 2012;
114(1):
11 - 45.
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[PDF]
|
|
|
|
|
|
|
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J. Am. Coll. Cardiol.,
December 6, 2011;
58(24):
2584 - 2614.
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[PDF]
|
|
|
|
|
|
|
L. D. Hillis, P. K. Smith, J. L. Anderson, J. A. Bittl, C. R. Bridges, J. G. Byrne, J. E. Cigarroa, V. J. DiSesa, L. F. Hiratzka, A. M. Hutter Jr, et al.
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58(24):
e123 - e210.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Writing Committee Members, L. D. Hillis, P. K. Smith, J. L. Anderson, J. A. Bittl, C. R. Bridges, J. G. Byrne, J. E. Cigarroa, V. J. DiSesa, L. F. Hiratzka, et al.
2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
Circulation,
December 6, 2011;
124(23):
e652 - e735.
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[PDF]
|
|
|
|
|
|
|
Writing Committee Members, L. D. Hillis, P. K. Smith, J. L. Anderson, J. A. Bittl, C. R. Bridges, J. G. Byrne, J. E. Cigarroa, V. J. DiSesa, L. F. Hiratzka, et al.
2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
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124(23):
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|
|
|
|
|
|
|
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Predicting in vivo cardiovascular properties of {beta}-blockers from cellular assays: a quantitative comparison of cellular and cardiovascular pharmacological responses
FASEB J,
December 1, 2011;
25(12):
4486 - 4497.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Girerd, J. Magne, P. Pibarot, P. Voisine, F. Dagenais, and P. Mathieu
Postoperative atrial fibrillation predicts long-term survival after aortic-valve surgery but not after mitral-valve surgery: a retrospective study
BMJ Open,
November 27, 2011;
1(2):
e000385 - e000385.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Bramer, A. H. M. van Straten, M. A. Soliman Hamad, E. Berreklouw, K. C. van den Broek, and J. G. Maessen
Body mass index predicts new-onset atrial fibrillation after cardiac surgery
Eur J Cardiothorac Surg,
November 1, 2011;
40(5):
1185 - 1190.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
X. Sun, S. W. Boyce, P. C. Hill, A. S. Bafi, Z. Xue, J. Lindsay, and P. J. Corso
Association of Body Mass Index With New-Onset Atrial Fibrillation After Coronary Artery Bypass Grafting Operations
Ann. Thorac. Surg.,
June 1, 2011;
91(6):
1852 - 1858.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. J. Siegel, S. Biner, A. M. Rafique, M. Rinaldi, S. Lim, P. Fail, J. Hermiller, R. Smalling, P. L. Whitlow, H. C. Herrmann, et al.
The Acute Hemodynamic Effects of MitraClip Therapy
J. Am. Coll. Cardiol.,
April 19, 2011;
57(16):
1658 - 1665.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
U. Schotten, S. Verheule, P. Kirchhof, and A. Goette
Pathophysiological Mechanisms of Atrial Fibrillation: A Translational Appraisal
Physiol Rev,
January 1, 2011;
91(1):
265 - 325.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Lee, H. Wu, J. M. Kalman, D. Esmore, T. Williams, G. Snell, and P. M. Kistler
Atrial fibrillation following lung transplantation: double but not single lung transplant is associated with long-term freedom from paroxysmal atrial fibrillation
Eur. Heart J.,
November 2, 2010;
31(22):
2774 - 2782.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. W. Bolderman, P. Bruin, J. J. R. Hermans, M. J. Boerakker, A. A. Dias, F. H. van der Veen, and J. G. Maessen
Atrium-targeted drug delivery through an amiodarone-eluting bilayered patch
J. Thorac. Cardiovasc. Surg.,
October 1, 2010;
140(4):
904 - 910.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Bramer, A. H. M. van Straten, M. A. Soliman Hamad, E. Berreklouw, E. J. Martens, and J. G. Maessen
The Impact of New-Onset Postoperative Atrial Fibrillation on Mortality After Coronary Artery Bypass Grafting
Ann. Thorac. Surg.,
August 1, 2010;
90(2):
443 - 449.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Dizon, K. Chen, M. Bacchetta, M. Argenziano, D. Mancini, A. Biviano, J. Sonett, and H. Garan
A Comparison of Atrial Arrhythmias After Heart or Double-Lung Transplantation at a Single Center: Insights Into the Mechanism of Post-Operative Atrial Fibrillation
J. Am. Coll. Cardiol.,
November 24, 2009;
54(22):
2043 - 2048.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Dixit
Atrial Fibrillation After Major Thoracic Surgery: New Insights Into Underlying Mechanisms
J. Am. Coll. Cardiol.,
November 24, 2009;
54(22):
2049 - 2051.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Miceli, R. Capoun, C. Fino, P. Narayan, A. J. Bryan, G. D. Angelini, and M. Caputo
Effects of Angiotensin-Converting Enzyme Inhibitor Therapy on Clinical Outcome in Patients Undergoing Coronary Artery Bypass Grafting
J. Am. Coll. Cardiol.,
November 3, 2009;
54(19):
1778 - 1784.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. S. Choi, J. K. Shim, S. W. Hong, D. H. Kim, J. C. Kim, and Y. L. Kwak
Risk factors of atrial fibrillation following off-pump coronary artery bypass graft surgery: predictive value of C-reactive protein and transfusion requirement
Eur J Cardiothorac Surg,
November 1, 2009;
36(5):
838 - 843.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Bouchardy, J. Therrien, L. Pilote, R. Ionescu-Ittu, G. Martucci, N. Bottega, and A. J. Marelli
Atrial Arrhythmias in Adults With Congenital Heart Disease
Circulation,
October 27, 2009;
120(17):
1679 - 1686.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Y. See, K. C. Roberts-Thomson, W. G. Stevenson, P. C. Camp, and B. A. Koplan
Atrial Arrhythmias After Lung Transplantation: Epidemiology, Mechanisms at Electrophysiology Study, and Outcomes
Circ Arrhythm Electrophysiol,
October 1, 2009;
2(5):
504 - 510.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Miceli, C. Fino, B. Fiorani, M. Yeatman, P. Narayan, G. D. Angelini, and M. Caputo
Effects of Preoperative Statin Treatment on the Incidence of Postoperative Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting
Ann. Thorac. Surg.,
June 1, 2009;
87(6):
1853 - 1858.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. I. Rossman, K. Liu, G. A. Morgan, R. E. Swillo, J. A. Krueger, S. J. Gardell, J. Butera, M. Gruver, J. Kantrowitz, H. S. Feldman, et al.
The Gap Junction Modifier, GAP-134 [(2S,4R)-1-(2-Aminoacetyl)-4-benzamido-pyrrolidine-2-carboxylic Acid], Improves Conduction and Reduces Atrial Fibrillation/Flutter in the Canine Sterile Pericarditis Model
J. Pharmacol. Exp. Ther.,
June 1, 2009;
329(3):
1127 - 1133.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Girerd, P. Pibarot, D. Fournier, P. Daleau, P. Voisine, G. O'Hara, J.-P. Despres, and P. Mathieu
Middle-aged men with increased waist circumference and elevated C-reactive protein level are at higher risk for postoperative atrial fibrillation following coronary artery bypass grafting surgery
Eur. Heart J.,
May 2, 2009;
30(10):
1270 - 1278.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. W. Khoo and G. Y. H. Lip
Acute Management of Atrial Fibrillation
Chest,
March 1, 2009;
135(3):
849 - 859.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. N. DeMaria, O. Ben-Yehuda, J. J. Bax, G. K. Feld, B. H. Greenberg, W. Y.W. Lew, J. A.C. Lima, A. S. Maisel, S. M. Narayan, D. J. Sahn, et al.
Highlights of the Year in JACC 2008
J. Am. Coll. Cardiol.,
January 27, 2009;
53(4):
373 - 398.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. R. Kapoor
Combination Prophylactic Therapy for Post-Operative Atrial Fibrillation
J. Am. Coll. Cardiol.,
July 29, 2008;
52(5):
397 - 397.
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Echahidi, P. Pibarot, G. O'Hara, and P. Mathieu
Reply
J. Am. Coll. Cardiol.,
July 29, 2008;
52(5):
397 - 398.
[Full Text]
[PDF]
|
|
|
|
