P1395The role of hyponatremia in the development of atrial fibrillation after cardiac surgery

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Pavlikova ◽  
A Shevelyok ◽  
N Vatutin
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Serum Sodium ◽  
Sodium Level ◽  
Cox Regression ◽  
Serum Sodium Level ◽  
History Of ◽  
The Impact

Abstract Background. Atrial fibrillation (AF) is one of the most common complication after cardiac surgeries. Age, valvular heart disease, heart failure, chronic obstructive pulmonary disease and a history of AF are well known risk factors for postoperative AF. On the other hand, hyponatremia is also a frequent disorder in patients undergoing cardiac surgery but its relationship with AF has not been studied. Purpose. We evaluated the impact of hyponatremia on the incidence of postoperative AF in patients undergoing cardiac surgery with cardiopulmonary bypass. Methods. The retrospective study included case history of 222 patients (174 men and 48 women, median age 64.5 [range 58.0; 69.0] years) who underwent cardiac surgery with cardiopulmonary bypass between January 2015 and December 2018.  In all patients intraoperative sodium level was analyzed. Hyponatremia was defined as serum sodium level < 135 mmol/l. Primary outcome was the episode of AF in postoperative period. Results. The incidence of postoperative AF was 18.9% (95% confidence interval (CI) 14.1-24.3 P = 0.05). Patients with AF more often had obesity, diabetes mellitus and a history of myocardial infarction and were more likely to perform combined surgery compared to non-AF patients (all Ps < 0.05). The prevalence of hyponatremia was significantly higher among AF group compared with non-AF (95.2% versus 77.8%, P = 0.017). Hyponatremia was the independent risk factors of postoperative AF in Cox regression models adjusted for covariates (odds ratio 5.31; 95% CI 1.42-18.7; P = 0.017). Conclusion.  In this analysis serum sodium level was closely associated with the risk of AF. These findings suggest that hyponatremia may cause the development of postoperative AF in patients undergoing cardiac surgery with cardiopulmonary bypass.

scholarly journals Risk Factors for Atrial Fibrillation following a Cardiac Surgery

2021 ◽  
Author(s):  
Ibrahim Marai ◽  
Wiaam Khatib ◽  
Liza Grosman-Rimon ◽  
Shemy Carasso ◽  
Ali Sakhnini ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Cox Regression ◽  
Medical Center ◽  
Clinical Impact ◽  
Cox Regression Analysis ◽  
History Of ◽  
Vascular Accidents ◽  
Preoperative Factors

Background: Atrial fibrillation (AF) following cardiac surgery is common and has clinical impact on morbidity. The preoperative and intraoperative risk factors are still not well defined. The objective of the study was to examine preoperative and intraoperative risk factors for AF following cardiac surgery. Methods: A retrospective analysis of a database of cardiac surgeries was performed during 2017-2019 at Poriya Medical Center. Preoperative factors and intraoperative were recorded. Results: 208 patients were included in this analysis. Overall AF following cardiac surgery was detected in 50 (24%) patients. Of 175 patients who did not have history of AF prior to surgery, 27 (15.5%) had post-operative AF. In the 33 patients with previous AF, AF following surgery was detected in 23 (70%). Patients with AF following surgery who were older (66.2±8.0 vs. 60.7± 11.4 years, p=0.002), were treated more with anti-arrhythmic drugs (18.9% vs 4.5, p<0.001), and had higher rates of pre-operative AF (46% vs 6.3%, p=0.0001), prior cerebral vascular accidents (14% vs 4.4%, p=0.019), and prior valve replacement (10% vs 1.9%, p=0.009) compared to patients without AF following surgery. In multivariate Cox regression analysis, age (HR 1.04, CI 1.01-1.07, P=0.006) and history of preoperative AF (HR 6.01, CI 3.42-10.57, P<0.001) were predictors of AF following cardiac surgery. The probability of being free of postsurgical AF was 80% among patients without history of AF compared to 30% in patients with previous AF history (p<0.001). Conclusion: Preoperative AF and age were predictors of AF following cardiac surgery

scholarly journals Clinical, biochemical and genetic risk factors for 30-day and 5-year mortality in 518 adult patients subjected to cardiopulmonary bypass during cardiac surgery - the INFLACOR study.

2018 ◽  
Vol 65 (2) ◽  
pp. 241-250 ◽  
Author(s):  
Maciej Michał Kowalik ◽  
Romuald Lango ◽  
Piotr Siondalski ◽  
Magdalena Chmara ◽  
Maciej Brzeziński ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Genetic Association ◽  
Biochemical Parameters ◽  
Cox Regression ◽  
Association Studies ◽  
Nyha Class ◽  
Genetic Association Studies ◽  
Chronic Obstructive

There is increasing evidence that genetic variability influence patients’ early morbidity after cardiac surgery performed using cardiopulmonary bypass (CPB). The use of mortality as an outcome measure in cardiac surgical genetic association studies is rare. We publish the 30-day and 5-year survival analyses with focus on pre-, intra-, postoperative variables, biochemical parameters, and genetic variants in the INFLACOR (INFlAmmation in Cardiac OpeRations) cohort.In a series of prospectively recruited 518 adult Polish Caucasians who underwent cardiac surgery in which CPB was used, the clinical data, biochemical parameters, IL-6, soluble ICAM-1, TNFa, soluble E-selectin, and 10 single nucleotide polymorphisms were evaluated for their associations with 30-day and 5-year mortality.The 30-day mortality was associated with: pre-operative prothrombin international normalized ratio, intra-operative blood lactate, postoperative serum creatine phosphokinase, and acute kidney injury requiring renal replacement therapy (AKI-RRT) in logistic regression. Factors that determined the 5-year survival included: pre-operative NYHA class, history of peripheral artery disease and severe chronic obstructive pulmonary disease, intra-operative blood transfusion; and postoperative peripheral hypothermia, myocardial infarction, infection, and AKI-RRT in Cox regression. The serum levels of IL-6 and ICAM-1 measured three hours after operation were associated with 30-day and 5-year mortality, respectively. The ICAM1 rs5498 was associated with 30-day and 5-year survival with borderline significance.Different risk factors determined the early (30-day) and late (5-year) survival after adult cardiac surgery in which cardiopulmonary bypass was used. Future genetic association studies in cardiac surgical patients should adjust for the identified chronic and acute postoperative risk factors.

The impact of low serum sodium level on mortality depends on glycemic control

2011 ◽  
Vol 42 (5) ◽  
pp. 534-540 ◽  
Author(s):  
Osman Z. Sahin ◽  
Gulay Asci ◽  
Fatih Kircelli ◽  
Mumtaz Yilmaz ◽  
Soner Duman ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Serum Sodium ◽  
Sodium Level ◽  
Serum Sodium Level ◽  
The Impact ◽  
Low Serum

scholarly journals Prevalence and Risk Factors for Hyponatremia in Preterm Infants

2019 ◽  
Vol 7 (19) ◽  
pp. 3201-3204
Author(s):  
Tran Kiem Hao
Keyword(s):  
Risk Factors ◽  
Preterm Infants ◽  
Serum Sodium ◽  
High Frequency ◽  
Retrospective Cohort ◽  
Sodium Level ◽  
Distress Syndrome ◽  
Serum Sodium Level ◽  
Preterm Newborns

BACKGROUND: Hyponаtremiа is the result of а negаtive sodium bаlаnce cаused by inаdequаte sаlt intаke or excessive sаlt loss due to immаture renаl or intestinаl function in preterm infаnts. AIM: The аim of our study was to define the incidence of аnd fаctors аffecting its development in preterm newborns. METHODS: This wаs а retrospective cohort аnаlysis of 126 preterm infаnts born before 36 weeks of gestаtion between June 2016 аnd July 2018 аt Neonаtаl Intensive Cаre Unit of Hue Centrаl Hospitаl, Vietnаm. Hyponаtremiа wаs defined аs а sodium level ≤ 132 mEq/L or 133-135 mEq/L with orаl sodium supplementаtion. We used the serum sodium level to define hyponаtremiа. RESULTS: There were 37 infаnts who hаd hyponаtremiа, аccounting for 29.4% of the infаnts enrolled in the study. А lower gestаtionаl аge, the presence of respirаtory distress syndrome, the use of furosemide, аnd feeding with breаst milk were significаnt risk fаctors for hyponаtremiа in preterm newborns. CONCLUSION: Hyponаtremiа occurred аt а relаtively high frequency. This result exemplifies the importаnce of serum sodium monitoring аnd supplementаtion for the correction of hyponаtremiа.

scholarly journals Sex differences in the predictors of recurrent atrial fibrillation after catheter ablation: insights from the Kansai Plus Atrial Fibrillation (KPAF) registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Tanaka ◽  
K Inoue ◽  
A Kobori ◽  
K Kazutai ◽  
T Morimoto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Sex Differences ◽  
Catheter Ablation ◽  
Large Scale ◽  
Funding Source ◽  
Recurrent Atrial Fibrillation ◽  
History Of ◽  
The Impact ◽  
Af Recurrence

Abstract Background The impact of sex differences on the clinical outcomes of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) is controversial. We previously reported that females experienced more frequent AF recurrences than males after the index and last RFCA procedures. Purpose To identify the risk factors associated with recurrent AF in females and males after RFCA of AF. Methods We conducted a large-scale, prospective, multicenter, observational study (Kansai Plus Atrial Fibrillation Registry). We enrolled 5010 consecutive patients who underwent an initial RFCA of AF at 26 centers (64±10 years; 1369 [27.3%] females; non-paroxysmal AF, 35.7%). The median follow-up duration was 2.9 years. Results The incidence of AF recurrences after a single procedure was 43.3% in females and 39.0% in males. After a multivariate adjustment at baseline, the significant predictors of AF recurrence in females after the index RFCA were non-paroxysmal AF (hazard ration [HR],1.59; 95% confidence interval [CI],1.31–1.93, p&lt;0.0001), a history of AF ≥2 years (HR,1.47; 95% CI,1.24–1.74, p&lt;0.0001), coronary artery disease (HR,1.43; 95% CI,1.03–1.98, p=0.0035), and an estimated glomerular filtration rate (eGFR)&lt;60 mL/min/1.73m2 (HR,1.46; 95% CI,1.10–1.95, p=0.0086). On the other hand, significant predictors of AF recurrence in males after the index RFCA were non-paroxysmal AF (HR,1.54; 95% CI,1.37–1.73, p&lt;0.0001), a history of AF ≥2 years (HR,1.40; 95% CI,1.26–1.56, p&lt;0.0001), the number of antiarrhythmic drugs (HR,1.06; 95% CI,1.003–1.13, p=0.040), a left atrial diameter≥40mm (HR,1.13; 95% CI,1.007–1.27, p=0.038), and dilated cardiomyopathy (HR,1.55; 95% CI,1.07–2.26, p=0.021), however, an eGFR&lt;60 mL/min/1.73m2 was not associated with AF recurrence in males (HR, 1.00; 95% CI, 0.88–1.13, p=0.97). Conclusion The Kansai Plus Atrial Fibrillation Registry revealed a distinct sex difference in terms of the predictors of recurrent AF after RFCA. Non-Paroxysmal AF and a long history of AF were common risk factors both in females and males. However, renal dysfunction was a significant predictor of AF recurrence in females, while it was not a risk of recurrence in males. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Research Institute for Production Development in Kyoto, Japan.

scholarly journals The impact of correcting the serum sodium level for total proteins in patients receiving parenteral nutrition

2015 ◽  
Author(s):  
Emilia Gomez Hoyos ◽  
Pilar Matia Martin ◽  
Martin Cuesta Hernandez ◽  
Teresa Ruiz Gracia ◽  
Natalia Perez Ferre ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Serum Sodium ◽  
Sodium Level ◽  
Serum Sodium Level ◽  
Total Proteins ◽  
The Impact

scholarly journals Prognostic Factors in Patients with an Implanted Pacemaker after 80 Years of Age in a 4-Year Follow-Up

Gerontology ◽  
2017 ◽  
Vol 64 (2) ◽  
pp. 107-117 ◽  
Author(s):  
Krystyna Krzemień-Wolska ◽  
Andrzej Tomasik ◽  
Celina Wojciechowska ◽  
Karolina Barańska-Pawełczak ◽  
Ewa Nowalany-Kozielska ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Favourable Prognosis ◽  
Treatment Type ◽  
Ventricular Lead ◽  
Pacing Mode ◽  
The Impact

Background: The controversy over electrotherapy for patients aged >80 years occurs already at the stage of qualification for this treatment type and concerns optimal device selection, the implantation strategy, and the overall benefit from pacemaker therapy. The group also has a considerable number of cardiovascular risk factors, and the data from the literature on the impact of the pacing mode on the remote prognosis of this group are ambiguous. Objective: Assessment of the risk factors for death among patients with implanted pacemakers >80 years of age in a 4-year follow-up. Methods: The study group consisted of 140 consecutive patients (79 women) aged 84.48 ± 3.65 years with single- or dual-chamber pacemakers implanted >80 years of age because of symptomatic bradycardia. In univariate and multivariate Cox regression analyses, demographic, echocardiographic, and laboratory parameters, pharmacotherapy, and factors related to the implanted device - i.e., indications, pacemaker type, and the implantation position of the tip of the right ventricular lead - were included. The endpoint was death for any reason in a 4-year follow-up. Results: During follow-up, 68 patients (48.6%) died. Although atrial fibrillation with a slow ventricular response constituted 20% of the indications for implantation, 60.8% of the patients received a single-chamber system (VVI/VVIR). In the whole group, the multivariate Cox regression analysis showed both a favourable prognostic significance of DDD pacing system implantation (HR = 0.507; 95% CI: 0.294-0.876) and coexisting hypertension (HR = 0.520; 95% CI: 0.299-0.902). The risk factors were fasting glycaemia (HR = 1.180; 95% CI: 1.038-1.342) and, potentially, female sex (HR = 1.672; 95% CI: 0.988-2.830; p = 0.056). In the female subgroup a more favourable prognosis was related to the use of angiotensin-converting enzyme inhibitors (HR = 0.435; 95% CI: 0.202-0.933) and DDD pacemaker implantation (HR = 0.381; 95% CI: 0.180-0.806). In the male subgroup a more favourable prognosis was related to concerned patients with coexisting hypertension (HR = 0.349; 95% CI: 0.079-0.689). Conclusions: DDD mode pacing seems to serve as a factor which decreases mortality among patients aged >80 years in long-term follow-up. The potentially poorer prognosis for the female patients in this group may result from a combination of the dominant VVI pacing mode, potential propagation of atrial fibrillation, a low proportion of antithrombotic therapy, and sex-related predispositions to thromboembolic complications.

scholarly journals Overweight and aging increase the risk of atrial fibrillation after cardiac surgery independently of left atrial size and left ventricular ejection fraction

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Pier Luigi Stefàno ◽  
Marco Bugetti ◽  
Guido Del Monaco ◽  
Gloria Popescu ◽  
Paolo Pieragnoli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Pleural Effusion ◽  
Left Ventricular Ejection Fraction ◽  
Operation Time ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Abstract Background Body mass index (BMI), age, left atrium (LA) dimension and left ventricular ejection fraction (LVEF) have been linked to post-operative atrial fibrillation (POAF) after cardiac surgery. The aim of this study was to better define the role of these risk factors. Methods This retrospective cohort study evaluated 249 patients (without prior atrial dysrhythmia) undergoing cardiac or aortic surgery. Prior to surgery, the following data were collected: age, BMI, LA diameter, LA area, LVEF, thyroid stimulating hormone (TSH), creatinine and the presence of arterial hypertension (AH) and diabetes. Intraoperative data such as operation time, total clamp time, cardiopulmonary bypass time, and presence of pericardial/pleural effusion were also collected. Only patients without pre- and post-surgery prophylactic anti-arrhythmic therapy were included. Results Patients with (N = 127, 51%) and without POAF (N = 122, 49%) were compared. No difference was observed for sex, LA diameter, LA area, LVEF, TSH, diabetes and use of ACE inhibitors or statins prior to intervention. Moreover, no difference was observed in terms of operation time, total clamp time, cardiopulmonary bypass time, and presence of pericardial/pleural effusion. However, patients with POAF were older (70.6 ± 10.7 vs. 60.4 ± 16.4 years, p = 0.001), had higher BMI (26.8 ± 4.5 vs. 24.9 ± 3.6 kg/m2, p = 0.001), higher baseline creatinine (1.06 ± 0.91 vs. 0.88 ± 0.32 mg/dL, p = 0.038) and a higher frequency of arterial hypertension (73.2% vs. 50%, p = 0.001) and Bentall procedure (24.4% vs. 9.8%, p = 0.023). Multivariate analysis showed that the only independent predictors of POAF were age (OR = 1.05, 95%CI 1.02–1.07, p = 0.001) and BMI (OR = 1.11 95%CI 1.03–1.2,p = 0.006). Conclusions These findings suggest that advanced age and a higher BMI are strong risk factors for POAF in patients without previous AF even in the presence of comparable LA dimensions and LVEF.

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