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J Am Coll Cardiol, 2004; 44:939, doi:10.1016/j.jacc.2004.05.034
© 2004 by the American College of Cardiology Foundation
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LETTER TO THE EDITOR

Serum potassium level and risk of postoperative atrial fibrillation in patients undergoing cardiac surgery": Reply

John E. MacDonald, MBChB, MRCP

Dundee University,Clinical Pharmacology, Level Seven, Ninewells Hospital, Dundee, Scotland DD1 9SY, United Kingdom

Allan D. Struthers, BSc, MD, FRCP, FESC

(Email: macdonald_je{at}hotmail.com).

We thank Auer et al. for their comments on our paper (1). Auer et al. would like to add atrial fibrillation (AF) after cardiac surgery to the list of cardiovascular disorders that are exacerbated by low serum potassium concentrations. Atrial fibrillation is a common and costly complication after cardiac surgery (2). It is significantly more common when serum potassium falls below 3.5 mmol/l, and avoidance of hypokalemia may reduce its incidence (3,4).

The stress of cardiothoracic surgery increases sympathetic tone, and this may predispose one to the development of AF. Interestingly, experimental evidence suggests that sympathetic activity reduces the arrhythmic threshold of hypokalemic dogs (5). This is unsurprising, given the data that link catecholamines with hypokalemia and the favorable effects of beta-blockade on the renin-angiotensin-aldosterone system (6,7).

Therefore, we agree that avoidance of perioperative hypokalemia in patients undergoing cardiothoracic surgery is likely to reduce the incidence of AF in this setting and avoid unnecessary morbidity and costs. A randomized controlled trial of targeted potassium repletion versus standard care is thus warranted.


   References
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 References
 

  1. Mac Donald JE, Struthers AD. What is the optimal serum potassium level in cardiovascular patients? J Am Coll Cardiol 2004;43:155-161.[Abstract/Free Full Text]
  2. Aranki SF, Shaw DP, Adams DH, et al. Predictors of atrial fibrillation after coronary artery surgery. Current trends and impact on hospital resources Circulation 1996;94:390-397.[Abstract/Free Full Text]
  3. Gaylard E. Changing incidence of atrial fibrillation following coronary artery bypass grafting: a retrospective analysis Br J Clin Pract 1996;50:164-165.[Medline]
  4. Wahr JA, Parks R, Boisvert D, et al. Preoperative serum potassium levels and perioperative outcomes in cardiac surgery patients. Multicenter Study of Perioperative Ischemia Research Group JAMA 1999;281:2203-2210.[Abstract/Free Full Text]
  5. Yano K, Mitsuoka T, Hirata T, Hano O, Hirata M, Matsumoto Y. Effect of bilateral stellectomy on electrical instability of the atrium in the dog with hypokalemia Pacing Clin Electrophysiol 1992;15:314-323.[Medline]
  6. Brown MJ, Brown DC, Murphy MB. Hypokalemia from beta2-receptor stimulation by circulating epinephrinel N Engl J Med 1983;309:1414-1419.[Abstract]
  7. Lijnen PJ, Amery AK, Fagard RH, Reybrouck TM, Moerman EJ, De Schaepdryver AF. The effects of beta-adrenoceptor blockade on renin, angiotensin, aldosterone and catecholamines at rest and during exercise Br J Clin Pharmacol 1979;7:175-181.[Medline]




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