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Late Atrial Arrhythmias as a Complication After Valvular Heart Surgery: Is There A Place for Prevention?

  • D. Mangino
  • A. Asta
  • A. Venturini
  • E. Polesel
  • R. Moretti
  • A. Terrini
  • C. Zussa
Conference paper

Abstract

Atrial arrhythmias, mostly atrial fibrillation (AF), are the most frequent complication after cardiac surgery. The incidence of postoperative AF (pAF) is 11–40% after coronary artery bypass grafting (CABG) [1–10] and over 50% after valve surgery [11, 12]. Technical advances in surgery and anesthesia and changing methods of myocardial protection have not decreased the incidence of postoperative atrial tachyarrhythmias. While the consequences of this arrhythmia are generally not life threatening (pAF), it can result in stroke, ventricular arrhythmia, pneumonia, and hemodynamic deterioration, especially in patients with depressed cardiac function. In addition, increased length and cost of hospital stay are observed. The underlying mechanism of recurrent AF in patients who are not undergoing surgery appears to be multiple, simultaneously propagating reentrant electrical impulses, or wavefronts, that circulate inside the atria. Less is known about the cause of pAF, for which other arrhythmogenic factors exist. Many factors have been tested as independent variables predictive of pAF, from systemic hypertension to postoperative bleeding, atrial manipulation, myocardial protection, cross-clamping time, excessive production of catecholamines, and respiratory or renal parameters [4, 7, 13, 14], but most have proved to be poorly correlated with the onset of pAF.

Keywords

Atrial Fibrillation Mitral Valve Coronary Artery Bypass Grafting Aortic Valve Replacement Mitral Stenosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Ormerod OJM, McGregor CGA, Stone DL, Wisbey C, Petch MC (1984) Arrhythmias after coronary by-pass surgery. Br Heart J 51:618–621PubMedCrossRefGoogle Scholar
  2. 2.
    Rubin DA, Niemiski KE, Reed GE, Hermann MV (1987) Predictors, prevention and long term prognosis of atrial fibrillation after by-pass graft operation. J Thorac Cardiovasc Surg 94:331–335PubMedGoogle Scholar
  3. 3.
    Lauer MS, Eagle KA, Buckley MJ, De Sanctis RW (1989) Atrial fibrillation following coronary bypass surgery. Prog Cardiovasc Dis 31:367–378PubMedCrossRefGoogle Scholar
  4. 4.
    Fuller JA, Adams GG, Buxton B (1989) Atrial fibrillation after coronary artery grafting: is it a disease of elderly? J Thorac Cardiovasc Surg 97:821–825PubMedGoogle Scholar
  5. 5.
    Yousif H, Davies G, Oakley CM (1990) Peri-operative supraventricular arrhythmias in coronary artery bypass surgery. Int J Cardiol 26:313–318PubMedCrossRefGoogle Scholar
  6. 6.
    Crosby LH, Woll KR, Wood KL, Pifalo WB (1990) Effect of activity on supraventricular tachyarrhythmias after coronary bypass surgery. Heart Lung 19:666–670PubMedGoogle Scholar
  7. 7.
    Frost L, Molgaard H, Christiansen EH et al (1992) Atrial fibrillation and flutter after coronary artery bypass surgery: epidemiology, risk factors and preventive trials. Int J Cardiol 36:253–261PubMedCrossRefGoogle Scholar
  8. 8.
    Cox JL (1993) A perspective of postoperative atrial fibrillation in cardiac operations. Ann Thorac Surg 56:405–409PubMedCrossRefGoogle Scholar
  9. 9.
    Pires LA, Wagshal AB, Lancey R, Huang S (1995) Arrhythmias and conduction disturbances after coronary artery bypass graft surgery: epidemiology, management and prognosis. Am Heart J 129:799–808PubMedCrossRefGoogle Scholar
  10. 10.
    Gaylord E (1996) Changing incidence of atrial fibrillation following coronary artery bypass grafting: a retrospective analysis. Br J Clin Pract 50:164–165Google Scholar
  11. 11.
    Ommen SR, Odell JA, Stanton MS (1997) Atrial arrhythmias after cardiothoracic surgery. N Engl J Med 336:1429–1434PubMedCrossRefGoogle Scholar
  12. 12.
    Asher CR, Miller DP, Grimm RA, Cosgrove DM, Chung MK (1998) Analysis of risk factors for development of atrial fibrillation early after cardiac valvular surgery. Am J Cardiol 87: 892–895CrossRefGoogle Scholar
  13. 13.
    Crosby LH, Pifalo WB, Woll KR, Burkholder JA (1990) Risk factor for atrial fibrillation after coronary artery coronary artery bypass grafting. Am J Cardiol 66:1520–1522PubMedCrossRefGoogle Scholar
  14. 14.
    Leitch JW, Thompson D, Baird DK, Harris PJ (1990) The importance of age as a predictor of atrial fibrillation and flutter after coronary bypass grafting. J Thorac Cardiovasc Surg 100:338–342PubMedGoogle Scholar
  15. 15.
    Andrews TC, Reimond SC, Berlin JA, Antman EM (1991) Prevention of supraventricular arrhythmias after coronary bypass surgery: a meta-analysis of randomized control trials. Circulation 84[Suppl III]:236–244Google Scholar
  16. 16.
    Guarnieri T, Nolan S, Gottlieb SO, Dudek A, Lowry DR (1999) Intravenous amiodarone for the prevention of atrial fibrillation after open heart surgery: the Amiodarone Reduction in Coronary Heart (ARCH) Trial. J Am Coll Cardiol 34:343–347PubMedCrossRefGoogle Scholar
  17. 17.
    Daud EG, Strickberger SA, Man KC et al (1997) Preoperative amiodarone as prophylaxis against atrial fibrillation after heart surgery. N Engl J Med 337:1785–1791CrossRefGoogle Scholar
  18. 18.
    Pfisterer MB, Kloter-Weber UCD, Huber M et al (1997) prevention of supraventricular tachyarrhythmias after open heart operation by low-dose sotalol: a prospective, double blind, randomized, placebo-controlled study. Ann Thorac Surg 64:1113–1119PubMedCrossRefGoogle Scholar
  19. 19.
    Jessurun ER, van Hemel NM, Kelder JC et al (2000) Mitral valve surgery and atrial fibrillation: is atrial fibrillation surgery also needed? Eur J Cardiothorac Surg 17:530–537PubMedCrossRefGoogle Scholar
  20. 20.
    Vogt PR, Brunner-La Rocca HP, Rist M et al (1998) Preoperative predictors of recurrent atrial fibrillation late after successful mitral valve reconstruction. Eur J Cardiothorac Surg 13:619–624PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2004

Authors and Affiliations

  • D. Mangino
    • 1
  • A. Asta
    • 1
  • A. Venturini
    • 1
  • E. Polesel
    • 1
  • R. Moretti
    • 1
  • A. Terrini
    • 1
  • C. Zussa
    • 1
  1. 1.Cardiovascular DepartmentUmberto I HospitalMestre-VeniceItaly

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