A novel treatment strategy of new onset atrial fibrillation after cardiac surgery: an observational prospective study

Mohamed Zeriouh,Georg Langebartels,Thorsten Wittwer,Hannes Reuter,Jens Wippermann,Yeong-Hoon Choi,Parwis B Rahmanian,Klaus Neef,Anton Sabashnikov,Thorsten Wahlers,Javid Fatullayev,Lucas Kimmig,Aron-Frederik Popov

doi:10.1186/1749-8090-9-83

Mohamed Zeriouh, Georg Langebartels + Show 11 more

Open Access

https://doi.org/10.1186/1749-8090-9-83

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Abstract

ObjectiveThe aim of this prospective observational study was to evaluate the efficiency of a new escalating treatment strategy with vernakalant, flecainide and electrical cardioversion (EC) in patients with new onset atrial fibrillation (AF) after cardiac surgery.Material and methods24 patients with new onset AF after aortic valve surgery, coronary artery bypass surgery or combined procedures were evaluated in this study. Additional including criteria were age between 18 and 80, duration of AF less than four days, body weight less than 100 kg and no previous treatment with class I or III antiarrhythmic drugs. Exclusion criteria were poor left ventricular ejection fraction (LVEF < 40%) and history of myocardial infarction within 30 days. The patients were divided into converters and non-converters according to their response to combination treatment with vernakalant and flecainide, and the groups were compared.ResultsThe mean age of the population was 69.6 ± 6.3 years and 26.1% of patients were female. There were no statistically significant differences between the two groups in terms of height, weight, gender distribution, comorbidities, preoperative medication, left ventricular function and left atrium diameter. Interventricular septum (IVS) in the non-converted group was significantly thicker compared to the converted group: 14.0 ± 1.00 vs. 10.40 ± 2.59 mm (p = 0.036). While 14 patients (60.9%) were successfully converted into stable sinus rhythm by pharmacological treatment with vernakalant and flecainide, 9 patients (39.1%, non-converted group) remained in AF. However, seven of them could be converted after additional EC.ConclusionThe combination of vernakalant and flecainide improves the conversion rate into a stable sinus rhythm in postcardiotomy patients with new onset AF compared to single drug therapy. Furthermore it might be an excellent precondition for successful EC in patients who are not converted after using both antiarrhtythmic drugs. Furthermore, left ventricular hypertrophy might be a potential negative predictor of successful pharmacological cardioversion.

Highlights

Postoperative atrial fibrillation (AF) is the most common complication after cardiac surgery, which occurs in up to 74% of patients who underwent on-pump and off-pump procedures [1,2]
The combination of vernakalant and flecainide improves the conversion rate into a stable sinus rhythm in postcardiotomy patients with new onset AF compared to single drug therapy
It might be an excellent precondition for successful electrical cardioversion (EC) in patients who are not converted after using both antiarrhtythmic drugs

Summary

Introduction

Postoperative atrial fibrillation (AF) is the most common complication after cardiac surgery, which occurs in up to 74% of patients who underwent on-pump and off-pump procedures [1,2]. After more than a century of research, the etiology and pathophysiology of this arrhythmia is still not completely understood [2,5]. There are several drugs, such as digitalis, Beta-blockers, calcium channel-blockers, and pharmacological or electrical cardioversion (EC), which were shown as efficient treatment strategies of AF in patients undergoing cardiac surgery [6]. The choice of treatment in each individual case depends on a number of factors, such as age, comorbidities and clinical status of patients with AF. Duration and etiology of AF play a major role in the treatment choice [7]

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