#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Is there a relationship between inflammatory markers, oxidative stress and postoperative atrial fibrillation?


Authors: F. Sabol 1;  M. Jakubová 2;  P. Mitro 3;  A. Bomba 4;  A. Chmelárová 4;  D. Petrášová 4;  B. Stančák 3;  V. Nagy 5;  P. Török 2;  A. Šebová 6
Authors‘ workplace: Klinika srdcovej chirurgie VÚSCH, a. s., Košice, Slovenská republika, prednosta MUDr. František Sabol, PhD. 1;  Klinika anestéziológie a intenzívnej medicíny VÚSCH, a. s., Košice, Slovenská republika, prednosta doc. MUDr. Pavol Török, CSc. 2;  Klinika kardiológie VÚSCH, a. s., Košice, Slovenská republika, prednosta doc. MUDr. Branislav Stančák, CSc. 3;  Ústav experimentálnej medicíny Lekárskej fakulty UPJŠ Košice, Slovenská republika, prednosta MVDr. Alojz Bomba, DrSc. 4;  Urologická klinika Lekárskej fakulty UPJŠ a UN L. Pasteura Košice, Slovenská republika, prednosta prof. MUDr. Ladislav Valanský, PhD. 5;  Klinika rádiodiagnostiky a nukleárnej medicíny UPJŠ a UN L. Pasteura Košice, Slovenská republika, prednosta doc. MUDr. Tatiana Jurgová, CSc. 6
Published in: Vnitř Lék 2012; 58(10): 730-734
Category: Original Contributions

Overview

Introduction:
Atrial fibrillation (AF) is one of the most common complications following heart surgery. The aim of this work was to verify the relationship between inflammatory markers, oxidative stress and postoperative arrhythmia.

Methods:
45 patients with ischemic heart disease (12 women and 33 men, mean age 62.3 ± 9.4 years) underwent surgical myocardial revascularization. The extracorporeal circulation (ECC) was used in 30 patients, without ECC was 15 patients. During the first 3 postoperative days was determining the incidence and duration of the AF, laboratory markers of inflammation (CRP, leukocytes, TNFα), malondialdehyde (MDA).

Results:
Demographic data and associated disease were in this patients similar. The incidence of AF we documented in 30 patients (66.7%). In patients with postoperative AF were significantly higher levels of inflammatory markers (leukocytes 13.6 ± 3.6 vs 11.3 ± 3.6; 14.7 ± 3.9 vs 12.5 ± 2.9; 13.7 ± 4.1 vs 11.4 ± 13.7; p ≤ 0.05; CRP 138.1 ± 41.1 vs 69.9 ± 25.8; p ≤ 0.001; TNFα 11.3 ± 14.3 vs 8.7 ± 3.6; 12.1 ± 14.5 vs 8.7 ± 3.1; p ≤ 0.05) compared with patients who were free from AF. Values of MDA were not significantly different.

Conclusion:
Patients with post­operative atrial fibrillation were higher levels of inflammatory markers compared with patients with sinus rhythm but no significant differences in the levels of oxidative stress.

Key words:
atrial fibrillation – heart surgery – inflammatory markers – oxidative stress – postoperative arrhythmia


Sources

1. Villareal RP, Hariharan R, Liu BC et al. Post­operative atrial fibrillation and mortality after coronary artery bypass surgery. J Am Coll Cardiol 2004; 43: 742–748.

2. Maisel WH, Rawn JD, Stevenson WG. Atrial fibrillation after cardiac surgery. Ann Intern Med 2001; 135: 1061–1073.

3. Echahidi N, Pibarot P, O’Hara G et al. Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery. J Am Coll Cardiol 2008; 51: 795–801.

4. Bharucha DB, Kowey PR. Management and prevention of atrial fibrillation after cardiovascular surgery. Am J Cardiol 2000; 85: 20D–24D.

5. Lonský V. Mimotělní oběh v klinické praxi. Praha: Grada publishing 2004.

6. Tselentakis EV, Woodford E, Chandy J et al. Inflammation effects on the electrical properties of atrial tissue and inducibility of postoperative atrial fibrillation. J Surg Res 2006; 13: 68–75.

7. Hogue CW Jr, Hyder ML. Atrial fibrillation after cardiac operation: risks, mechanisms, and treatment. Ann Thorac Surg 2000; 69: 300–306.

8. Hammon JW. Extracorporeal circulation: organ damage. In: Cohn LH (ed.). Cardiac Surgery in the Adult. New York: McGraw-Hill 2008: 389–414.

9. Ishii Y, Schuessler RB, Gaynor SL et al. Inflammation of atrium after cardiac surgery is associated with inhomogeneity of atrial conduction and atrial fibrillation. Circulation 2005; 111: 2881–2888.

10. Podgoreanu MV, Mathew JP. Prophylaxis against postoperative atrial fibrillation: current progress and future directions. JAMA 2005; 294: 3140–3142.

11. Kirklin JK, Westaby S, Blackstone EH et al. Complement and the damaging effects of cardiopulmonary bypass. J Thorac Cardiovasc Surg 1983; 86: 845–857.

12. Paparella D, Yau T, Young E. Cardiopulmonary bypass induced inflammation: patho­physiology and treatment: an update. Eur J Cardiothorac Surg 2002; 21: 232–244.

13. Brasil LA, Gomes WJ, Salomão R et al. Inflammatory response after myocardial revascularization with or without cardiopulmonary bypass. Ann Thorac Surg 1998; 66: 56–59.

14. Strüber M, Cremer JT, Gohrbandt B et al. Human cytokine responses to coronary artery bypass grafting with and without cardiopulmonary bypass. Ann Thorac Surg 1999; 68: 1330–1335.

15. Lo B, Fijnheer R, Nierich AP et al. C-reactive protein is a risk indicator for atrial fibrillation after myocardial revascularization. Ann Thorac Surg 2005; 79: 1530–1535.

16. Archbold RA, Curzen NP. Off-pump coronary artery bypass graft surgery: the incidence of postoperative atrial fibrillation. Heart 2003; 89: 1134–1137.

17. Abdelhadi RH, Gurm HS, Van Wagoner DR et al. Relation of an exaggerated rise in white blood cells after coronary bypass or cardiac valve surgery to development of atrial fibrillation post-operatively. Am J Cardiol 2004; 93: 1176–1178.

18. Lamm G, Auer J, Weber T et al. Post-operative white blood cell count predicts atrial fibrillation after cardiac surgery. J Cardiothorac Vasc Anesth 2006; 20: 51–56.

19. Bruins P, Velthuis H, Yazdanbakhsh AP et al. Activation of the complement system during and after cardiopulmonary bypass surgery: postsurgery activation involves C-reactive protein and is associated with postoperative arrhythmia. Circulation1997; 96: 3542–3548.

20. Boos CJ, Anderson RA, Lip GY. Is atrial fibrillation and inflammatory disorder? Eur Heart J 2006; 27: 136–149.

21. Buffolo E, Branco JN, Gerola LR et al. Off-pump myocardial revascularization: critical analysis of 23 years’ experience in 3,866 pa­tients. Ann Thorac Surg 2006; 81: 85–89.

22. Chamberlain MH, Ascione R, Reeves BC et al. Evaluation of the effectiveness of off-pump coronary artery bypass grafting in high-risk patients: an observational study. Ann Thorac Surg 2002; 73: 1866–1873.

23. Rastan AJ, Bittner HB, Gummert JF et al. On--pump beating heart versus off pump coronary artery bypass surgery-evidence of pump-induced myocardial injury. Eur J Cardiothorac Surg 2005; 27: 1057–1064.

24. Ascione R, Liolyd CT, Underwood MJ et al. Inflammatory response after coronary revascularization with or without cardiopulmonary bypass. Ann Thorac Surg 2000; 69: 1198–1204.

25. Scott BH, Seifert FC, Glass PS et al. Blood use in patients undergoing coronary artery bypass surgery: impact of cardiopulmonary bypass pump, hematocrit, gender, age, and body weight. Anesth Analg 2003; 97: 958–963.

26. Matata BM, Sosnowski AW, Galiñanes M. Off-pump bypass graft operation significantly reduces oxidative stress and inflammation. Ann Thorac Surg 2000; 69: 785–791.

27. Johansson-Synnergren M, Nilsson F, Bengtsson A et al. Off-pump CABG reduces complement activation but does not significantly affect peripheral endothelial function: a prospective randomized study. Scand Cardiovasc J 2004; 38: 53–58.

28. Athanasiou T, Aziz O, Mangoush O et al. Do off-pump techniques reduce the incidence of postoperative atrial fibrillation in elderly patients undergoing coronary artery bypass grafting? Ann Thorac Surg 2004; 77: 1567–1574.

29. Wagner R. Kardioanestezie a perioperační péče v kardiochirurgii. Praha: Grada Publishing 2009.

30. Uchiyama M, Mihara M. Determination of malonaldehyde precursor in tissues by thio­barbituric acid test. Anal Biochem 1978; 86: 271–278.

31. van Dijk D, Nierich A, Jansen E et al. Early outcome after off-pump versus on-pump coronary bypass surgery: results from a randomized study. Circulation 2001; 104: 1761–1766.

32. Jakubová M, Družbacká Ľ, Stančák B et al. Prečo vzniká fibrilácia predsiení po kardiochirurgických operáciách? Vnitř Lék 2011; 57: 92–96.

33. Camm AJ, Kirchhoff P, Lip GY et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 2010; 31: 2369–2429.

Labels
Diabetology Endocrinology Internal medicine

Article was published in

Internal Medicine

Issue 10

2012 Issue 10

Most read in this issue
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#