A Plasma-Based, Amiodarone-Impregnated Material Decreases Susceptibility to Atrial Fibrillation in a Post–Cardiac Surgery Model

2016 ◽  
Vol 11 (1) ◽  
pp. 59-63 ◽  
Author(s):  
David Schwartzman ◽  
Vinay Badhwar ◽  
Robert L. Kormos ◽  
Jason D. Smith ◽  
Phil G. Campbell ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Relative Reduction ◽  
Conduction Time ◽  
Atrial Electrophysiology ◽  
Histologic Evaluation ◽  
Sinus Cycle Length ◽  
System Activation ◽  
The Impact ◽  
Post Cardiac Surgery

Objective This study aimed to test the impact of a plasma-based, material (PBM) impregnated with amiodarone on atrial electrophysiology and atrial fibrillation susceptibility in a porcine post–cardiac surgery model. Methods Ten healthy pigs underwent implantation of transvenous pacing systems, after which sterile talc was infused into the pericardial sac via a pericardiotomy. In five animals, PBM was applied to the atrial epicardial surface just before talc infusion. Electrophysiologic evaluations were performed using the pacing system immediately after chest closure and 7 days later. Atrial histologic evaluations were performed. Results Immediately after chest closure, there were no significant differences in electrophysiologic parameters between talc-only and talc + PBM animals, and atrial fibrillation was largely noninducible. On postsurgical day 7, electrophysiologic evaluation revealed significantly shorter sinus cycle length and atrioventricular nodal refractoriness among talc-only animals relative to talc + PBM animals, possibly suggesting attenuated sympathetic nervous system activation in the latter. Atrial fibrillation inducibility and duration were significantly greater among talc-only animals. No significant differences in atrial refractoriness or conduction time between groups were apparent. Histologic evaluation revealed a relative reduction in epicardial inflammation and less myolysis among talc + PBM animals. Conclusions Epicardial application of a plasma-based, amiodarone-impregnated material was associated with a significant reduction in atrial inflammation and susceptibility to fibrillation.

Post–Cardiac Surgery Atrial Fibrillation

2021 ◽  
Vol 13 (1) ◽  
pp. 133-140
Author(s):  
Jason D. Matos ◽  
Frank W. Sellke ◽  
Peter Zimetbaum
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Post Cardiac Surgery

scholarly journals Landiolol for managing atrial fibrillation in post-cardiac surgery

2018 ◽  
Vol 20 (suppl_A) ◽  
pp. A4-A9 ◽  
Author(s):  
Jean-Luc Fellahi ◽  
Matthias Heringlake ◽  
Johann Knotzer ◽  
William Fornier ◽  
Laure Cazenave ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Post Cardiac Surgery

Impact of atrial fibrillation on in-hospital outcomes among hospitalizations for cardiac surgery: an analysis of the National Inpatient Sample

2022 ◽  
pp. jim-2021-001864
Author(s):  
Kanishk Agnihotri ◽  
Paris Charilaou ◽  
Dinesh Voruganti ◽  
Kulothungan Gunasekaran ◽  
Jawahar Mehta ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Valve Replacement ◽  
Failure Time ◽  
Artery Bypass ◽  
Bypass Graft ◽  
National Inpatient Sample ◽  
Inpatient Mortality ◽  
Hospitalization Costs ◽  
The Impact

The short-term impact of atrial fibrillation (AF) on cardiac surgery hospitalizations has been previously reported in cohorts of various sizes, but results have been variable. Using the 2005–2014 National Inpatient Sample, we identified all adult hospitalizations for cardiac surgery using the International Classification of Diseases, Ninth Revision, Clinical Modification as any procedure code and AF as any diagnosis code. We estimated the impact of AF on inpatient mortality, length of stay (LOS), and cost of hospitalization using survey-weighted, multivariable logistic, accelerated failure-time log-normal, and log-transformed linear regressions, respectively. Additionally, we exact-matched AF to non-AF hospitalizations on various confounders for the same outcomes. A total of 1,269,414 hospitalizations were noted for cardiac surgery during the study period. Coexistent AF was found in 44.9% of these hospitalizations. Overall mean age was 65.6 years, 40.9% were female, mean LOS was 11.6 days, and inpatient mortality was 4.5%. Stroke rate was lower in AF hospitalizations (1.8% vs 2.1%, p<0.001). Mortality was lower in the AF (3.9%) versus the non-AF (5%) group (exact-matched OR or emOR=0.48, 95% CI 0.29 to 0.80, p<0.001; 987 matched pairs, n=2423), with similar results after procedural stratification: isolated valve replacement/repair (emOR=0.38, p<0.001), isolated coronary artery bypass graft (CABG) (emOR=0.33, p<0.001), and CABG with valve replacement/repair (emOR=0.55, p<0.001). A 12% increase was seen in LOS in the AF subgroup (exact-matched time ratio=1.12, 95% CI 1.10 to 1.14, p<0.001) among hospitalizations which underwent valve replacement/repair with or without CABG. Hospitalizations for cardiac surgery which had coexistent AF were found to have lower inpatient mortality risk and stroke prevalence but higher LOS and hospitalization costs compared with hospitalizations without AF.

Rationale and Design of the Randomized Controlled Trial of New Oral Anticoagulants vs. Warfarin for post Cardiac Surgery Atrial Fibrillation

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Asishana A. Osho ◽  
Philicia Moonsamy ◽  
Breanna R. Ethridge ◽  
Gregory A. Leya ◽  
David A. D’Alessandro ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Randomized Controlled Trial ◽  
Cardiac Surgery ◽  
Controlled Trial ◽  
Oral Anticoagulants ◽  
New Oral Anticoagulants ◽  
Randomized Controlled ◽  
Post Cardiac Surgery

scholarly journals Preoperative Atrial Fibrillation is associated with long-term morTality in patients undergoing suRgical AortiC valvE Replacement

2021 ◽  
Author(s):  
Mohamed Farag ◽  
Yusuf Kiberu ◽  
Ashwin Reddy ◽  
Ahmad Shoaib ◽  
Mohaned Egred ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Surgical Aortic Valve Replacement ◽  
Term Survival ◽  
The Impact ◽  
Long Term Mortality

Introduction Atrial fibrillation (AF) is frequent after any cardiac surgery, but evidence suggests it may have no significant impact on survival if sinus rhythm (SR) is effectively restored early after the onset of the arrhythmia. In contrast, management of preoperative AF is often overlooked during or after cardiac surgery despite several proposed protocols. This study sought to evaluate the impact of preoperative AF on mortality in patients undergoing isolated surgical aortic valve replacement (AVR). Methods We performed a retrospective, single-centre study involving 2,628 consecutive patients undergoing elective, primary isolated surgical AVR from 2008 to 2018. A total of 268/ 2,628 patients (10.1%) exhibited AF before surgery. The effect of preoperative AF on mortality was evaluated with univariate and multivariate analyses. Results Short-term mortality was 0.8% and was not different between preoperative AF and SR cohorts. Preoperative AF was highly predictive of long-term mortality (median follow-up of 4 years [Q1-Q3 2-7]; HR: 2.24, 95% CI: 1.79-2.79, P<0.001), and remained strongly and independently predictive after adjustment for other risk factors (HR: 1.54, 95% CI: 1.21-1.96, P<0.001) compared with preoperative SR. In propensity score-matched analysis, the adjusted mortality risk was higher in the AF cohort (OR: 1.47, 95% CI: 1.04-1.99, P=0.03) compared with the SR cohort. Conclusions Preoperative AF was independently predictive of long-term mortality in patients undergoing isolated surgical AVR. It remains to be seen whether concomitant surgery or other preoperative measures to correct AF may impact long-term survival.

scholarly journals Radiofrequency ablation as a concomitant procedure for the treatment of atrial fibrillation during cardiac surgery

2019 ◽  
Vol 8 (2) ◽  
pp. 108-115
Author(s):  
Kaushal K Tiwari ◽  
Tommaso Gasbarri ◽  
Stefano Bevilacqua ◽  
Manish Jawarkar ◽  
Mausam Shah ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Radiofrequency Ablation ◽  
Maze Procedure ◽  
Pubmed Central ◽  
Concomitant Procedure ◽  
Cardiac Procedures ◽  
Number Of Patients ◽  
Study Type ◽  
The Impact

Atrial fibrillation is the most common type of arrhythmia with increasing burden for stroke and thromboembolic events. Medical treatment of atrial fibrillation has not shown promising results, so alternative method of treatment is emerging out. Cox-Maze procedure has been used for decades for the treatment of atrial fibrillation. Surgical treatment of atrial fibrillation with traditional Cox-Maze procedure is a complex and technically challenging procedure limiting its use in clinical practice. Recently, radiofrequency ablation is being used as a modification of Cox-Maze procedure. However, its effect in the treatment of atrial fibrillation in not reported uniformly and in large number of patients. Therefore, our aim of study was to assess the impact of concomitant radiofrequency ablation in the treatment of atrial fibrillation during cardiac surgery. We performed literature review on PubMed Central to evaluate effect of concomitant radiofrequency ablation for atrial fibrillation treatment. About 303 papers were found using the reported search, of which 15 represented suitable to fulfill our query. The authors, date, patient group, study type, relevant outcomes and results of these papers are tabulated. We conclude that radiofrequency ablation surgery of left atrium at the time of other cardiac procedures is a comparatively straightforward procedure with satisfactory freedom from atrial fibrillation, acceptable morbidity, mortality, and minor procedure related complications. Careful patients selection by sticking to the - Rule of 5, i.e. left atrial diameter less than 55 mm and atrial fibrillation duration no more than five years, is recommended to optimize the result of atrial fibrillation surgery.

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 &lt; 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 &lt; 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.

Warfarin-Induced Rapid Rise in INR Post–Cardiac Surgery Is Not Associated With Increased Bleeding Risk

2019 ◽  
Vol 53 (12) ◽  
pp. 1184-1191 ◽  
Author(s):  
Logan M. Olson ◽  
Andrea M. Nei ◽  
Ross A. Dierkhising ◽  
David L. Joyce ◽  
Scott D. Nei
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Warfarin Dose ◽  
Retrospective Chart Review ◽  
Female Gender ◽  
Bleeding Risk ◽  
Hospital Length Of Stay ◽  
Rapid Rise ◽  
The Impact ◽  
Post Cardiac Surgery

Background: Post–cardiac surgery bleeding can have devastating consequences, and it is unknown if warfarin-induced rapid international normalized ratio (INR) rise during the immediate postoperative period increases bleed risk. Objective: To determine the impact of warfarin-induced rapid-rise INR on post–cardiac surgery bleeding. Methods: This was a single-center, retrospective chart review of post–cardiac surgery patients initiated on warfarin at Mayo Clinic Hospital, Rochester. Patients were grouped based on occurrence or absence of rapid-rise INR (increase ≥1.0 within 24 hours). The primary outcome compared bleed events between groups. Secondary outcomes assessed hospital length of stay (LOS) and identified risk factors associated with bleed events and rapid rise in INR. Results: During the study period, 2342 patients were included, and 56 bleed events were evaluated. Bleed events were similar between rapid-rise (n = 752) and non–rapid-rise (n = 1590) groups in both univariate (hazard ratio [HR] = 1.22; P = 0.594) and multivariable models (HR = 1.24; P = 0.561). Those with rapid-rise INR had longer LOS after warfarin administration (discharge HR = 0.84; P = 0.0002). The most common warfarin dose immediately prior to rapid rise was 5 mg. Risk factors for rapid-rise INR were low body mass index, female gender, and cross-clamp time. Conclusion and Relevance: This represents the first report to assess warfarin-related rapid-rise INR in post–cardiac surgery patients and found correlation to hospital LOS but not bleed events. Conservative warfarin dosing may be warranted until further research can be conducted.

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