Abstract 4102: Preoperative Angiotensin Blocking Drug Therapy Does Not Reduce Atrial Fibrillation After Cardiac Surgery

Introduction: Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery. Angiotensin blocking drug therapy (ABDT) with Angiotensin converting enzyme (ACE) inhibitors and Angiotensin II receptor blockers (ARBs) has been shown to have anti-arrhythmic effects in animal models. However, data from small observational studies of ABDT use in patients undergoing cardiac surgery had discordant results and did not sufficiently adjust for selection bias. Therefore, we performed the largest study to date examining the association between preoperative use of ABDT and postoperative atrial fibrillation. Methods and Results: A consecutive series of 10,552 patients underwent coronary artery bypass graft (CABG) surgery with or without valvular surgery at Cleveland Clinic between 1997 through 2002. Of these 4,795 (45%) patients were on ABDT within 30 days prior to surgery and 3,633 (34%) patients developed POAF prior to discharge. Without adjusting for patient co-morbidities, ABDT had an Odds Ratio (OR) of 1.13 (95% Confidence Interval (CI) 1.05–1.25, p<0.01). A propensity score matched sample was developed, adjusting for 68 potential confounders. In the 6874 matched patients, who had a well balanced co-morbidity profile, ABDT was not associated with POAF (OR 1.03, CI 0.93–1.12, p=0.67). A subsequent propensity score matched analysis of 3227 patients, who underwent isolated valvular surgery in the same timeframe, also demonstrated ineffectiveness of preoperative ABDT (OR 0.91, CI 0.74 –1.09, p=0.33), irrespective of valve location. Stratified analysis by linear propensity score quintiles and propensity-adjusted logistic multivariable regression analysis of all patients in the CABG and the valvular surgery cohort confirmed these findings. Conclusions: In this large observational study preoperative use of ACE inhibitors or ARBs did not reduce postoperative occurrence of atrial fibrillation in patients undergoing cardiac surgery. Although withdrawal from ABDT prior to surgery is common practice and could account for this result, we cannot recommend such therapy for primary prophylaxis without larger randomized controlled trials.

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Subacute postoperative atrial fibrillation after heart surgery: incidence and predictive factors in cardiac rehabilitation

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.326 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

V Rizza ◽

F Maranta ◽

L Cianfanelli ◽

R Grippo ◽

C Meloni ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Hospital Stay ◽

Heart Surgery ◽

Troponin T ◽

Management Strategies ◽

Inpatient Rehabilitation ◽

Postoperative Atrial Fibrillation ◽

Funding Sources ◽

Valvular Surgery

Abstract Funding Acknowledgements Type of funding sources: None. Background. Postoperative atrial fibrillation (POAF) is the most common arrhythmic complication following cardiac surgery. It may occur between the second and fourth postoperative days as acute POAF, or within 30 days as subacute POAF (sPOAF). The incidence varies from 15% to 60%, with the highest rates observed in patients undergoing valvular surgery. POAF is associated with longer hospital stay and higher thromboembolic risk, which consistently increase patients’ morbidity and mortality. Identification of high-risk categories may allow optimization of in-hospital prevention and treatment, possibly improving clinical outcomes. Aim of the study. The aim of this study was to assess the incidence of sPOAF and to identify possible predictors in patients performing Cardiovascular Rehabilitation (CR) after Cardiac Surgery (CS). Methods. A single-centre retrospective study was performed on 383 post-cardiac surgery patients hospitalised in our CR Unit for inpatient rehabilitation. The entire population was on sinus rhythm at the admission in CR and continuous monitoring with 12-lead ECG telemetry was performed during the hospital stay. We calculated the incidence of sPOAF and then evaluated the predictive value of the following variables: anamnestic data, type of cardiac intervention, clinical course in both CS and CR Unit, laboratory parameters including baseline neutrophil-to-lymphocyte ratio (NLR). Results. Median age was 65 years (63% male). sPOAF was documented in 122 cases (31.9%). Patients developing sPOAF were older [median age 69 (63-76) vs. 61 (51-70); p < 0.001)], more frequently underwent complex surgical procedures (50% vs. 36%; p = 0.009) and were known for previous episodes of atrial fibrillation (27.9% vs. 11.2%; p < 0.001). On the first day after surgery (T1), sPOAF group showed higher values of glycemia [median 155 (126.5–186.8) vs. 129 (106.5–164); p < 0.001] and troponin T [median 721.5 (470.1–1084.3) vs. 488 (301.6-776.2); p < 0.001]. The multivariate analysis identified advanced age (OR 1.04, 95% CI 1.01-1.08; p = 0.023), acute POAF in the Cardiac Surgery Unit (OR 3.51, 95% CI 1.62-7.59; p = 0.001), baseline NLR (OR 1.46, 95% CI 1.10-1.93; p = 0.008) and T1-troponin > 552 ng/L (OR 4.16 95% CI 1.50-11.53; p = 0.006) as independent risk predictors of sPOAF during the CR period. Conclusions. sPOAF is common after cardiac surgery occurring in 31.9% of patients during CR. Age, acute POAF, baseline NLR and elevated troponin T on the first postoperative day were shown predictors of increased sPOAF risk. Recognition of new predictors of POAF could be helpful to better stratify patients, improving management strategies and outcomes.

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LEFT ATRIAL APPENDAGE CLOSURE DURING ROUTINE CARDIAC SURGERY INCREASES THE RISK OF POSTOPERATIVE ATRIAL FIBRILLATION AND DOES NOT REDUCE THE RISK OF STROKE: A PROPENSITY SCORE MATCHED ANALYSIS OF 9,833 PATIENTS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(15)60287-x ◽

2015 ◽

Vol 65 (10) ◽

pp. A287

Author(s):

Rowlens Melduni ◽

Eloka Ikebudu ◽

Rakesh Suri ◽

Hon-Chi Lee ◽

Stephen Cha ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Propensity Score ◽

Left Atrial ◽

Left Atrial Appendage ◽

Postoperative Atrial Fibrillation ◽

Atrial Appendage ◽

Left Atrial Appendage Closure

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Preoperative angiotensin-blocking drug therapy is not associated with atrial fibrillation after cardiac surgery

American Heart Journal ◽

10.1016/j.ahj.2010.05.033 ◽

2010 ◽

Vol 160 (2) ◽

pp. 329-336.e1 ◽

Cited By ~ 17

Author(s):

Florian Rader ◽

David R. Van Wagoner ◽

A. Marc Gillinov ◽

Eugene H. Blackstone

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Drug Therapy ◽

Blocking Drug

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Long Term Outcome of Postoperative Atrial Fibrillation After Cardiac Surgery—A Propensity Score-Matched Cohort Analysis

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.650147 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jung-Chi Hsu ◽

Chen-Yu Huang ◽

Shu-Lin Chuang ◽

Hsu-Yu Yu ◽

Yih-Sharng Chen ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Ischemic Stroke ◽

Propensity Score ◽

Cohort Analysis ◽

Postoperative Atrial Fibrillation ◽

Long Term Outcome ◽

Increased Risk ◽

Overall Mortality

Background: Postoperative atrial fibrillation (POAF) results in a longer hospital stay and excess mortality. However, whether POAF would increase stroke rate has been debated for years. When and how long should anticoagulation be used to prevent stroke are unknown. In the study, we planned to investigate the clinical demographics and long-term outcomes of POAF after cardiac surgery in a single-center cohort.Methods: The cohort study used a database from National Taiwan University Hospital, a single tertiary medical center in Taiwan, between 2007 and 2017, to identify patients with prior normal sinus rhythm developing POAF after cardiac surgery. Patients without POAF after cardiac surgery were used as controls. Propensity score matching with 1:1 ratio and Cox regression models were employed to estimate the risk of transient ischemic accident (TIA) or ischemic stroke.Results: From 2007 to 2017, a total of 8,374 patients received open-heart surgery, in which 1,585 patients with a history of AF were excluded. The overall incidence of TIA/ischemic stroke was 3.9% in a median 9.2-years of follow-up. After propensity matching, 1,965 matched paired subjects were included for analysis. Postoperative atrial fibrillation was associated with an increased risk of future AF [Hazard ratio (HR) 1.40, 95% confidence interval (95%CI) = 1.09–1.79, p = 0.008] and heart failure (HF) hospitalization (HR 1.58, 95%CI 1.23–2.04, p < 0.001); however, POAF did not significantly correlate with the risk of TIA/ischemic stroke (HR 1.17, 95%CI 0.85–1.60, p = 0.043). Kaplan-Meier analysis showed that POAF was a significant predictor for future AF, HF hospitalization, and overall mortality, but not for TIA/ischemic stroke.Conclusion: In the Asian population, POAF after cardiac surgery increased the risk of future AF, HF, and overall mortality, but was not associated with future TIA/ischemic stroke.

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Preoperative Antihypertensive Medication in Relation to Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery: A Meta-Analysis

BioMed Research International ◽

10.1155/2017/1203538 ◽

2017 ◽

Vol 2017 ◽

pp. 1-12

Author(s):

Ai-Guo Zhou ◽

Xian-Xue Wang ◽

Dao-Bo Pan ◽

An-ji Chen ◽

Xiong-fei Zhang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Ace Inhibitors ◽

Calcium Antagonists ◽

Antihypertensive Medication ◽

Meta Analysis ◽

Postoperative Atrial Fibrillation ◽

Cochrane Library ◽

Blocking Agents ◽

Beta Blocking

Background. We undertake a systematic review and meta-analysis to evaluate the effect of preoperative hypertension and preoperative antihypertensive medication to postoperative atrial fibrillation (POAF) in patients undergoing cardiac surgery. Methods. We searched PubMed, Embase, and Cochrane Library (from inception to March 2016) for eligible studies. The outcomes were the effects of preoperative hypertension, preoperative calcium antagonists regimen, preoperative ACE inhibitors regimen, and preoperative beta blocking agents regimen with POAF. We calculated pooled risk ratios (OR) and 95% CIs using random- or fixed-effects models. Results. Twenty-five trials involving 130087 patients were listed. Meta-analysis showed that the number of preoperative hypertension patients in POAF group was significantly higher (P<0.05), while we found that there are no significant differences between two groups in Asia patients by subgroup analysis, which is in contrast to other outcomes. Compared with the Non-POAF group, the number of patients who used calcium antagonists and ACE inhibitors preoperatively in POAF group was significantly higher (P<0.05). And we found that there were no significant differences between two groups of preoperative beta blocking agents used (P=0.08). Conclusions. Preoperative hypertension and preoperative antihypertensive medication in patients undergoing cardiac operations seem to be associated with higher risk of POAF.

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Faculty Opinions recommendation of Randomized trial of atorvastatin for reduction of postoperative atrial fibrillation in patients undergoing cardiac surgery: results of the ARMYDA-3 (Atorvastatin for Reduction of MYocardial Dysrhythmia After cardiac surgery) study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1046730.496737 ◽

2006 ◽

Author(s):

Patrick Wouters

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Randomized Trial ◽

Postoperative Atrial Fibrillation

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Increasing Occurrence of Postoperative Atrial Fibrillation in Contemporary Cardiac Surgery

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2016.02.013 ◽

2016 ◽

Vol 30 (5) ◽

pp. 1302-1307 ◽

Cited By ~ 6

Author(s):

Jahangir Khan ◽

Niina Khan ◽

Eetu Loisa ◽

Jaakko Sutinen ◽

Jari Laurikka

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Postoperative Atrial Fibrillation

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Epicardial Adipose Tissue and Postoperative Atrial Fibrillation

10.21203/rs.3.rs-588749/v1 ◽

2021 ◽

Author(s):

Petraglia Laura ◽

Conte Maddalena ◽

Comentale Giuseppe ◽

Cabaro Serena ◽

Campana Pasquale ◽

...

Keyword(s):

Atrial Fibrillation ◽

Adipose Tissue ◽

Cardiac Surgery ◽

Epicardial Adipose Tissue ◽

Perioperative Period ◽

Postoperative Atrial Fibrillation ◽

Serum Samples ◽

Monocyte Chemoattractant Protein 1 ◽

Elective Cardiac Surgery ◽

Increased Risk

Abstract Background. Atrial fibrillation (AF) often occurs after cardiac surgery and is associated to increased risk of stroke and mortality. Several evidence support the important role of inflammation in the pathogenesis of postoperative atrial fibrillation (POAF). It is known that an increased volume and a pro-inflammatory phenotype of epicardial adipose tissue (EAT) are both associated with AF onset in non surgical context. In the present study, we aim to evaluate whether also POAF occurrence may be triggered by an exalted production of inflammatory mediators from EAT.Methods. The study population was composed of 105 patients, with no history of paroxysmal or permanent AF, undergoing elective cardiac surgery. After clinical evaluation, all patients performed an echocardiographic study including the measurement of EAT thickness. Serum samples and EAT biopsies were collected before surgery. Levels of 10 inflammatory cytokines were measured in serum and EAT conditioned media. After surgery, cardiac rhythm was monitored for 7 days.Results. Forty-four patients (41.3%) developed POAF. As regard to cardiovascular therapy, only statin use was significantly lower in POAF patients (65.1% vs. 84.7%; p-0.032). Levels of Monocyte Chemoattractant Protein-1 (MCP-1), in both serum and EAT, were significantly higher in POAF patients (130.1 pg/ml vs. 68.7 pg/ml; p = < 0.001; 322.4 pg/ml vs. 153.4 pg/ml; p = 0.028 respectively). EAT levels of IL-6 were significantly increased in POAF patients compared to those in sinus rhythm (126.3 pg/ml vs. 23 pg/ml; p = < 0.005).ConclusionHigher EAT levels of IL6 and MCP1 are significantly associated with the occurrence of POAF. Statin therapy seems to play a role in preventing POAF. These results might pave the way for a targeted use of these drugs in the perioperative period.

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