Abstract
BackgroundPostoperative atrial fibrillation (POAF) is commonplace after cardiothoracic surgery. A rate control strategy using short-acting beta blockers is recommended as a first-line therapy in patients without hemodynamic instability. Microcirculatory effects of POAF and esmolol have not yet been investigated. We hypothesized that POAF without hemodynamic instability would induce microvascular dysfunction which could be reversed by intravenous esmolol.MethodsTwenty-five cardiothoracic surgical patients with POAF were included in the study. Microcirculation was assessed by peripheral near-infrared spectroscopy (NIRS) in association with a vascular occlusion test (VOT) before esmolol infusion, during incremental doses of esmolol (25, 50, 100, and 200 μg/kg/min), and after a return to sinus rhythm. Esmolol was given to control heart rate to between 60 and 90 beats/min. Regional tissue oxygen saturation variables (StO2, StO2 min, StO2 max, and ∆StO2) and desaturation/resaturation speeds during VOT were recorded to evaluate the microcirculation.ResultsStO2 and resaturation speed were significantly improved when POAF returned to sinus rhythm (StO2 64% ± 6 versus 67% ± 6, P < 0.01; resaturation speed 0.53%/s (0.42–0.97) versus 0.66%/s (0.51–1.04), P = 0.020). ∆StO2 was significantly decreased after a return to sinus rhythm (7.9% ± 4.8 versus 6.1% ± 4.7, P = 0.026). During esmolol infusion, we found a significant decrease in both heart rate (P < 0.001) and blood pressure (P < 0.001), and a non-significant dose-dependent increase in StO2 (P = 0.081) and resaturation speed (P = 0.087).ConclusionPOAF without hemodynamic instability is associated with significant impairment in the microcirculation which could be partially reversed by intravenous esmolol.
Highlights
Postoperative atrial fibrillation (POAF) is commonplace after cardiothoracic surgery
Patients with POAF leading to hemodynamic instability, usual esmolol contraindications, non-agreement, or permanent atrial fibrillation were not included into the study
A significant decrease in heart rate was observed when POAF returned to sinus rhythm (133 ± 22 beats/min versus 79 ± 13 beats/min, P < 0.001)
Summary
Postoperative atrial fibrillation (POAF) is commonplace after cardiothoracic surgery. A rate control strategy using short-acting beta blockers is recommended as a first-line therapy in patients without hemodynamic instability. Postoperative atrial fibrillation (POAF) is commonplace after cardiothoracic surgery [1], leading to an increase in mortality, morbidity, length of stay in hospital, and health costs [2, 3]. When POAF is not associated with hemodynamic instability, a ventricular rate control strategy using beta blockers is recommended [4]. The microcirculatory effects of both POAF and intravenous esmolol have not yet been investigated in this specific setting. The use of intravenous esmolol has been found to improve the microcirculation despite negative effects on macrocirculation parameters [22, 23]
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