CORRESPONDENCE: LETTER TO THE EDITOR
Reply
Leopoldo Bianconi, MD* and
Leonardo Calò, MD, FESC
* Department of Cardiac Diseases, S. Filippo Neri Hospital, Cardiology, Via Buonarroti 16, Marino, Rome 00047, Italy (Email: leonardo.calo{at}tin.it).
In our study (1) we observed a reduced incidence of atrial fibrillation (AF) following coronary artery bypass surgery in patients receiving polyunsaturated fatty acids (PUFAs). The way these compounds could have determined this result is, at present, only speculative. Indeed, PUFAs have been demonstrated to have a direct anti-arrhythmic effect in different laboratory models, but the importance of a concurrent (or prevalent) anti-inflammatory action cannot be excluded. In fact, PUFAs have anti-inflammatory properties (2), and inflammation, as correctly pointed out by Dr. Korantzopoulos and colleagues can play a fundamental role in postcardiac surgery AF. Actually, the efficacy of an anti-inflammatory therapy in this setting is still not clear owing to conflicting reports. Whereas a single postinduction steroid administration was shown to prevent postoperative AF (3), a similar protocol was found ineffective in other hands (4). The debate on this subject is thus still open, but unfortunately a further contribution cannot be obtained by our study, because C-reactive protein (CRP) levels or other inflammatory indexes were not routinely collected in our patients.
Concerning off-pump surgery that could carry a lower risk of AF due to a lesser oxidative and inflammatory response, aside from reports supporting this assumption (5) there are other studies that do not confirm this finding (6). In our study the incidence of AF was similar in patients receiving off-pump surgery (26.3% of 19 cases) and those submitted to on-pump surgery (24.1% of 141 cases). However, our population is too scarce to draw any conclusion on this subject.
Statins have been reported to prevent AF both after cardiac surgery (7) and after electrical cardioversion (8), possibly by their pleiotropic anti-inflammatory action. In our examination we did not observe any difference in AF incidence between patients on statins (24.2% of 91 patients) and those not on statins (24.6% of 61 patients). This could be due to the fact that the mean dose of statins in our patients was low (15.3 ± 9.2 mg/day simvastatin and 13.2 ± 7.5 mg/day atorvastatin) and the anti-inflammatory and thus, possibly, anti-arrhythmic effect of statins seems to be related to the dose. In fact, a recent study reported a significant decrease of CPR (–36.4%) with atorvastatin 80 mg but not with pravastatin 40 mg (–5.2%) (9).
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References
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- Calò L, Bianconi L, Colivicchi F, et al. N-3 fatty acids for the prevention of atrial fibrillation after coronary artery bypass surgery. A randomized, controlled trial J Am Coll Cardiol 2005;45:1723-1728.[Abstract/Free Full Text]
- Mori TA, Beilin LJ. Omega-3 fatty acids and inflammation Curr Atheroscler Rep 2004;6:4161-4167.
- Yared JP, Starr NJ, Torres FK, et al. Effects of single-dose, postinduction dexamethasone on recovery after cardiac surgery Ann Thorac Surg 2000;69:1420-1424.[Abstract/Free Full Text]
- Halvorsen P, Reader J, White PF, et al. The effect of dexamethasone on side effects after coronary revascularization procedures Anesth Analg 2003;96:1578-1583.[Abstract/Free Full Text]
- Matata BM, Sosnowski AW, Galinanes M. Off-pump bypass graft operation significantly reduces oxidative stress and inflammation Ann Thorac Surg 2000;69:785-791.[Abstract/Free Full Text]
- Enc Y, Ketenci B, Ozsoy D, et al. Atrial fibrillation after surgical revascularizationis there any diference between on-pump and off-pump?. Eur J Cardiothorac Surg 2004;26:1129-1133.[Abstract/Free Full Text]
- Dotani MI, Elnicki M, Jain AC, Gibson CM. Effect of preoperative statin therapy and cardiac outcomes after coronary bypass grafting Am J Cardiol 2000;86:1128-1130.[CrossRef][ISI][Medline]
- Siu CW, Lau CP, Tse HF. Prevention of atrial fibrillation recurrence by statin therapy in patients with lone atrial fibrillation after successful cardioversion Am J Cardiol 2003;92:1343-1345.[CrossRef][ISI][Medline]
- Nissen SE, Tuzcu EM, Schoenhagen P, et al. Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosisa randomized controlled trial. JAMA 2004;291:1071-1080.[Abstract/Free Full Text]
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References