oru.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Postoperative atrial fibrillation is not correlated to C-reactive protein
Örebro University, School of Health and Medical Sciences.ORCID iD: 0000-0002-6913-0669
Örebro University, School of Health and Medical Sciences.
2007 (English)In: Annals of Thoracic Surgery, ISSN 0003-4975, E-ISSN 1552-6259, Vol. 83, no 4, p. 1332-1337Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The peak incidence of postoperative atrial fibrillation (AF) occurs around the second postoperative day, a time at which serum inflammatory markers are elevated. The aim of this study was to investigate differences between patients with and without postoperative AF with special regard to C-reactive protein (CRP) serum levels. METHODS: The study cohort included all heart surgery patients who had sinus rhythm preoperatively, survived postoperative day 3, and were operated on between July 1, 2004, and June 30, 2005 (n = 524). Any episode of AF during the first 7 postoperative days defined the patient as belonging to the postoperative AF group. Creatine kinase-myocardial band (CK-MB) was measured at postoperative day 1, and CRP was measured preoperatively and at postoperative day 3. Risk factors for postoperative AF were determined using bivariate and multivariate regression analysis. RESULTS: Of 524 patients, 182 had at least one episode of AF (34.7%). Preoperative and postoperative CRP concentrations did not differ between the groups (postoperative CRP 175.4 +/- 64.4 versus 175.3 +/- 60.1 mg/L respectively, p = 0.99). Atrial fibrillation patients were significantly older (p < 0.001) and had higher CK-MB levels (33.6 +/- 53.1 microg/L versus 22.5 +/- 26.7 microg/L, respectively, p = 0.009). The odds ratio for postoperative AF with postoperative CK-MB greater than 70 microg/L was 3.5 (confidence interval: 1.4 to 8.6). CONCLUSIONS: Postoperative AF has no correlation to the inflammatory marker CRP in heart surgery patients. Ischemic myocardial injury might predispose for postoperative AF.

Place, publisher, year, edition, pages
2007. Vol. 83, no 4, p. 1332-1337
National Category
Medical and Health Sciences Surgery Surgery
Research subject
Surgery esp. Thoracic and Cardivascular Surgery
Identifiers
URN: urn:nbn:se:oru:diva-2986DOI: 10.1016/j.athoracsur.2006.11.047PubMedID: 17383336OAI: oai:DiVA.org:oru-2986DiVA, id: diva2:136242
Available from: 2008-09-01 Created: 2008-09-01 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Atrial fibrillation in cardiac surgery
Open this publication in new window or tab >>Atrial fibrillation in cardiac surgery
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Atrial fibrillation (AF) is the most common arrhythmia seen in clinical practice. In cardiac surgery, one-third of the patients experience episodes of AF during the first postoperative days (postoperative AF), and patients with preoperative AF (concomitant AF) can be offered ablation procedures in conjunction with surgery, in order to restore ordinary sinus rhythm (SR). The aim of this work was to study the relation between postoperative AF and inflammation; the long-term consequences of postoperative AF on mortality and late arrhythmia; and atrial function after concomitant surgical ablation for AF.

In 524 open-heart surgery patients, C-reactive protein (CRP) serum concentrations were measured before and on the third day after surgery. There was no correlation between levels of CRP and the development of postoperative AF.

All 1,419 patients with no history of AF, undergoing primary aortocoronary bypass surgery (CABG) in the years 1997–2000 were followed up after 8.0 years. The mortality rate was 191 deaths/1,000 patients (19.1%) in patients with no AF and 140 deaths/419 patients (33.4%) in patients with postoperative AF. Postoperative AF was an age-independent risk factor for late mortality, with a hazard ratio (HR) of 1.56 (95% CI 1.23–1.98). Postoperative AF patients had a more than doubled risk of death due to cerebral ischaemia, myocardial infarction, sudden death, and heart failure compared with patients without AF.

All 571 consecutive patients undergoing primary CABG during the years 1999–2000 were followed-up after 6 years. Questionnaires were obtained from 91.6% of surviving patients and an electrocardiogram (ECG) from 88.3% of all patients. In postoperative AF patients, 14.1% had AF at follow-up, compared with 2.8% of patients with no AF at surgery (p<.001). An episode of postoperative AF was found to be an independent risk factor for development of late AF, with an adjusted risk ratio (RR) of 3.11 (95% CI 1.41–6.87).

Epicardial microwave ablation was performed in 20 open-heart surgery patients with concomitant AF. Transthoracic echocardiography was performed preoperatively and at 6 months postoperatively. At 12 months postoperatively 14/19 patients (74%) were in SR with no anti-arrhythmic drugs. All patients in SR had preserved left and right atrial filling waves (A-waves) and Tissue velocity echocardiography (TVE) showed preserved atrial wall velocities and atrial strain.

In conclusion, postoperative AF is an independent risk factor for late mortality and later development of AF. There is no correlation between the inflammatory marker CRP and postoperative AF. Epicardial microwave ablation of concomitant AF results in SR in the majority of patients and seems to preserve atrial mechanical function.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2008. p. 101
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 18
Keyword
Atrial fibrillation, Inflammation, CABG surgery, Survival analysis, Follow-up studies, Ablation, Microwave, Transmurality, Atrial function, Tissue velocity echocardiography
National Category
Surgery
Research subject
Surgery esp. Thoracic and Cardivascular Surgery
Identifiers
urn:nbn:se:oru:diva-2442 (URN)978-91-7668-615-7 (ISBN)
Public defence
2008-09-19, Wilandersalen, Universitetssjukhuset, Örebro, 09:00 (English)
Opponent
Supervisors
Available from: 2008-09-01 Created: 2008-09-01 Last updated: 2017-10-18Bibliographically approved

Open Access in DiVA

No full text in DiVA

Other links

Publisher's full textPubMed

Authority records BETA

Ahlsson, Anders J.Englund, Anders G.

Search in DiVA

By author/editor
Ahlsson, Anders J.Englund, Anders G.
By organisation
School of Health and Medical Sciences
In the same journal
Annals of Thoracic Surgery
Medical and Health SciencesSurgerySurgery

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 416 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf