Prevention Of Postoperative Atrial Fibrillation Research Articles

Omega-3 polyunsaturated fatty acids in the prevention of postoperative atrial fibrillation in open heart surgery: a systematic review and meta-analysis

Aim. To evaluate the literature data on the efficacy of omega-3 polyunsaturated fatty acids (PUFAs) in the prevention of postoperative atrial fibrillation (POAF) in elective cardiac surgery, including onor off-pump coronary artery bypass grafting and/or valve replacement and/or repair.Material and methods. The search for studies was carried out using the PubMed database and Google Scholar from 2005 to January 31, 2022. From the initially identified search results, 19 articles were analyzed. The design of articles corresponded to randomized clinical trials. Omega-3 PUFAs was selected as an interventional effect. The studies were to include, as an end point, the assessment of new POAF cases in the early period after open heart surgery.Results. The meta-analysis included 15 studies with 3980 patients, of which 1992 (50,0%) patients took omega-3 PUFAs. POAF occurred in 587 (29,5%) patients receiving omega-3 PUFAs and 679 (34,2%) patients on standard therapy (hazard ratio, 0,8, 0,68-0,93, p=0,004). There is a variation in effect size for POAF patients in the presented randomized clinical trials relative to the axis of the central trend and heterogeneity of studies with a significant number of patients included (I2=51%, p=0,01).Conclusion. Our systematic review and meta-analysis showed the effectiveness of omega-3 PUFAs in the prevention of POAF during open heart surgery.

Effect of Magnesium Sulfate in Prevention of Postoperative Atrial Fibrillation Arrhythmia among Candidates of CABG Surgery with Abnormal P-wave Duration

Background: Cardiac arrhythmias, especially atrial fibrillation, are among the most common early complications of open-heart surgery. Hypomagnesemia is one of the clinical mechanisms associated with the pathogenesis of postoperative atrial fibrillation. This study aimed to evaluate the effect of magnesium sulfate on the prevention of atrial fibrillation in patients with abnormal P-wave duration who underwent coronary artery bypass graft (CABG)surgery. Methods: In this clinical trial, 150 patients participated who had undergone CABG surgery at Imam Khomeini hospital in Ahvaz in 2014. According to the inclusion criteria, the intervention and control groups were randomly matched. The intervention group, consisting of 57 patients, received 2.4 g of magnesium sulfate daily for three days and 75 patients of the control group received a placebo. Prevention of postoperative atrial fibrillation by magnesium sulfate was evaluated in patients and data were analyzed using SPSS software. Results: The two groups did not have a significant difference in terms of gender, diabetes, hyperlipidemia, and hypertension. Also, mean P-wave duration, length of intensive care unit stay, the total length of hospitalization, left ventricular ejection fraction (LVEF), distribution of creatinine, atrial fibrillation, and aortic clamp time in intervention and control groups were not statistically significant. Only, the total pump duration difference was reported to be statistically significant between groups. Conclusion: The results of our study showed that the administration of magnesium sulfate alone cannot be helpful in the prevention of atrial fibrillation among patients with long P-wave duration. Trial Registration: https://www.irct.ir/, Identifier: IRCT2015092814190N9

Colchicine for prevention of post-operative atrial fibrillation: Meta-analysis of randomized controlled trials.

This study intended to assess the efficacy of colchicine for prevention of post-operative atrial fibrillation (AF). Post-operative AF is a common complication of surgery operations. Inflammation plays a crucial role in the pathogenesis of post-operative AF. Colchicine, a potent anti-inflammatory drug, may have a role in mitigating the incidence of post-operative AF. We searched Cochrane Library, Web of Science, PubMed, China National Knowledge Infrastructure (CNKI), Database of Chinese sci-tech periodicals (COVIP), and Wanfang Database for randomized controlled trials (RCTs) comparing colchicine versus placebo, or usual care for prevention of post-operative AF. The main outcome was the occurrence of AF post operation, which includes cardiac surgery, lung surgery, or pulmonary vein isolation. The estimated risk ratio (RR) for the occurrence of post-operative AF was evaluated using a random-effects model. The safety end point was the development of any side effects. A total of 12 RCTs with 2274 patients were eventually included in this meta-analysis, where 1141 patients received colchicine and 1133 patients received placebo or usual care. Perioperative colchicine treatment was related to a decreased incidence of post-operative AF (RR: 0.65; 95% confidence interval [CI]: 0.56 to 0.75, p<0.001). Although the incidence of gastrointestinal side effects was increased with colchicine therapy when compared to placebo (RR = 2.49, 95% CI 1.85 to 3.34, p < 0.001), the incidence of major adverse events was not increased (RR = 0.86, 95% CI 0.46 to 1.60, p = 0.64). In conclusion, the results of our meta-analysis suggest that colchicine treatment could lower the incidence of post-operative AF. Further studies are needed to determine the optimal colchicine treatment regime to minimize the incidence of adverse events.

Pre-operative N-Acetyl Cysteine for Prevention of Atrial Fibrillation After CABG Surgery in Pakistan

Objective: To determine the effect of NAC in prevention of post-operative atrial fibrillation in patients undergoing CABG.&#x0D; Study Design: Quasi experimental study.&#x0D; Place and Duration of Study: Adult Cardiac Intensive Care Unit, Armed Forces Institute of Cardiology &amp; National Institute of Heart Diseases (AFIC&amp;NIHD) Rawalpindi during 6 months.&#x0D; Methodology: 146 patients of both gender undergoing elective CABG were included in the study, having age between 30-70 years. However, any patient with history of arrhythmia including AF, thyroid dysfunction, ejection fraction less than 25%, any valvular lesion, dilated left atrium, dilated left ventricle, dilated right atrium, dilated right ventricle or having right atrial tear during surgery were excluded from the study. By using non-probability consecutive sampling, patients were divided into two groups by using envelope method. One group was given standard treatment (control group) while other group was named as NAC group (experimental group). Data analysis was performed using SPSS version-23. Descriptive statistics were reported as Mean±SD. Categorical variables were reported as frequency and percentage. Chi square test and T-test was used to determine association between different variables.&#x0D; Results: A total of 146 patients with mean age 55.27±7.3 yrs. 127(87%) were male and 19(13%) were females. 28(19.2%) patients had atrial fibrillation while 11(7.5%) patients had ventricular premature contractions (VPC). There was no statistically significant difference between ages (p=0.784), gender (p=0.461), AF (p=0.207) and VPC (p=0.347). Out of 73 (50%) patients from each group; the mean age of NAC group was 55.41±7.3 yrs and of control group was 55.08±7.1 yrs (p=0.784). Gender wise distribution of NAC group had 8(11%) females and 65(89%) males while in control group 11(15%) females and 62(85%) were males. AF was found to be 11(15%) and 17(23.3%) in NAC and control group respectively. In NAC group, VPC was 4 (5.5%) and in control group it was 66 (90.4%).&#x0D; Conclusion: This study shows that NAC decreases the frequency of post-operative atrial fibrillation and ventricular premature contractions, but the decrease is statistically insignificant in Pakistani population. However, keeping in view other beneficial effects of NAC, we would recommend more studies on this subject in Pakistani population.

Abstract 9901: In-Hospital and 30-day Post-Discharge Outcomes Associated With Postoperative Atrial Fibrillation: A Contemporary Analysis From the Society of Thoracic Surgeons Adult Cardiac Surgery Database

Introduction: Postoperative atrial fibrillation (POAF) is associated with worse in-hospital and post-discharge morbidity and mortality. However, current estimates vary widely among published studies due to limited study centers and differing patient populations. The objective of this study was to assess the risk-adjusted in-hospital and 30-day post-discharge clinical outcomes associated with POAF in the United States. Methods: A contemporary, retrospective study was conducted using the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery database. The sample consisted of patients aged 40 to 90 who underwent open-chest coronary artery bypass and/or valvular surgery between 2011 to 2019. In-hospital and 30-day post-discharge clinical outcomes were compared between those who experienced POAF and those who did not (controls). Outcomes were risk-adjusted, where appropriate, for baseline demographics and prior medical and surgical history using a multivariable regression approach. Results: A total of 424,590 patients with a mean age of 69.3 (SD 9.2) years and 1,105,200 patients with a mean age of 64.8 (SD 10.2) years were identified in the POAF and control cohorts respectively, representing a POAF cumulative incidence of 27.8%. POAF patients experienced on average a postoperative length of stay that was 2.4 days longer (p &lt; 0.001) and 32 additional hours (p &lt; 0.001) in the intensive care unit compared to control patients. After risk adjustment, POAF was associated with 64% higher odds of in-hospital stroke (OR 1.64, 95% CI 1.59, 1.69), 158% higher odds of in-hospital renal failure (OR 2.58, 95% CI 2.52, 2.64), 29% higher odds of in-hospital mortality (OR 1.29, 95% CI 1.26, 1.32), 23% higher odds of 30-day readmission (OR 1.23 95% CI 1.21, 1.25), and 27% higher odds of 30-day mortality (OR 1.27, 95% CI 1.24, 1.30). Conclusions: POAF is associated with a significantly increased risk of both in-hospital and 30-days post-discharge morbidity and mortality. This study highlights the unmet need for more effective POAF prevention strategies.

Outcome of New-Onset Postoperative Atrial Fibrillation After Cardiac Surgery in Adults With Congenital Heart Disease.

Postoperative atrial fibrillation (POAF) is one of the most common complications after cardiac surgery. POAF is associated with a longer hospital stay, higher healthcare resource utilization, and higher risk of morbidity and mortality. As a result, the American and European guidelines recommend the use of beta-blockers and amiodarone for the prevention of POAF, and in turn, avoid the complications associated with POAF. The purpose of this study was to determine the incidence, risk factors, and prognostic implications of new-onset POAF after cardiac surgery in adults with congenital heart disease (CHD). A retrospective study was conducted among adults with CHD who underwent cardiac surgery (2003-2019). POAF and late-onset atrial fibrillation (AF) were defined as AF occurring within and after 30days postoperatively, respectively. Of 1,598 patients (mean age 39 ± 13 years, 51% men), 335 (21%) developed POAF. Risk factors associated with POAF were older age, hypertension, left atrial (LA) reservoir strain and right atrial (RA) dysfunction, and nonsystemic atrioventricular valve regurgitation. Of 1,291 patients (81%) with follow-up≥12months, the annual incidence oflate-onset AF was 1.5% and was higher in patients with POAF compared with those without POAF (5.9% vs 0.4%; P<0.001). Risk factors associated with late-onset AF were POAF, older age, severe CHD, and LA and RA dysfunction. Of the 1,291 patients, 63 (5%) died during follow-up, and the risk factors associated with all-cause mortality were older age, severe CHD, hypertension, left ventricular systolic dysfunction, and LA and RA dysfunction. POAF was not associated with all-cause mortality. POAF was common in adults with CHD and was associated with late-onset AF but not all-cause mortality. Atrial dysfunction was independently associated with POAF, late-onset AF, and all-cause mortality. These risk factors can be used to identify patients at risk for POAF and provide a foundation for prospective studies assessing the efficacy of prophylactic therapies in this population.

Colchicine in Cardiac Surgery: The COCS Randomized Clinical Trial.

Background. In patients who underwent cardiac surgery, first-time postoperative atrial fibrillation (POAF) is associated with increased incidence of hospital-acquired complications and mortality. Systemic inflammation is one of confirmed triggers of its development. The anti-inflammatory properties of colchicine can be effective for the POAF prevention. However, the results of several studies were questionable and required further investigation. Hence, we aimed to evaluate the effectiveness of low-dose short-term colchicine administration for POAF prevention in patients after the open-heart surgery. This double-blind randomized placebo-controlled trial included 267 patients, but 27 of them dropped out in the course of the study. Study subjects received the test drug on the day before the surgery and on postoperative days 2, 3, 4 and 5. The rhythm control was conducted immediately after the operation and until the discharge from the hospital. The final analysis included 240 study subjects: 113 in the colchicine group and 127 in the placebo group. POAF was observed in 21 (18.6%) patients of the colchicine group vs. 39 (30.7%) control patients (OR 0.515; 95% Cl 0.281–0.943; p = 0.029). We observed no statistically significant differences between the patient groups in the secondary endpoints of the study (hospital mortality, respiratory failure, stroke, bleeding, etc.). For other parameters characterizing the severity of inflammation (pericardial effusion, pleural effusion, WBC count, neutrophil count), there were statistically significant differences between the groups in the early postoperative period (days 3 and 5). Also, statistically significant differences between the groups in the frequency of adverse events were revealed: the incidence of diarrhea in the colchicine group was 25.7% vs. 11.8% in the placebo group (OR 2.578; 95% Cl 1.300–5.111; p = 0.005); for abdominal pain, incidence values were 7% vs. 1.6%, correspondingly (OR 4.762; 95% Cl 1.010–22.91; p = 0.028). Thus, there were statistically significant differences between groups in the primary endpoint, thereby confirming the effectiveness of short-term colchicine use for the POAF prevention after coronary artery bypass grafting and/or aortic valve replacement. Also, we detected statistically significant differences between groups in the frequency of side effects to colchicine: diarrhea and abdominal pain were more common in the colchicine group. This clinical trial is registered with ClinicalTrials database under a unique identifier: NCT04224545.

Amiodarone versus beta-blockers for the prevention of postoperative atrial fibrillation after cardiac surgery: An updated systematic review and meta-analysis of randomised controlled trials

Background: Amiodarone and beta-blockers are widely used as prophylaxis for postoperative atrial fibrillation (AF). The current recommendations from society guidelines are inconclusive, leading to differing practices among physicians. This meta-analysis aimed to compare the efficacy of both agents in preventing postoperative AF after cardiac surgery. Methods: We explored online medical databases, such as CINAHL, CENTRAL, MEDLINE, and EMBASE for randomised controlled trials (RCTs) comparing amiodarone and beta-blocker for prevention of AF after cardiac surgery. Outcomes analysed in this study were AF number of events and duration, hospital stay, and mean ventricular rate. Heterogeneity was assessed using the I² test, and publication bias was analysed using Egger’s test. Results: In total, eight RCTs comprising 1370 patients met the inclusion criteria. Pooled analysis showed that patients in both groups had no significant difference in both AF episodes (RR 0.83, 95% CI 0.66 to 1.04, p=0.10) and AF duration (SMD 0.46, 95% CI -1.14 to 2.05, p=0.57). Furthermore, secondary outcome analysis on mean ventricular rate and mean hospital length of stay in both groups showed no significant difference (MD -4.48, 95% CI -14.36 to 5.39, p=0.37 and MD 0.29, 95% CI -0.06 to 0.63, p=0.11, respectively). Conclusions: Amiodarone and beta-blockers are equally effective in preventing postoperative atrial fibrillation after cardiac surgery, with no difference in AF episode and duration, mean ventricular rate, and hospital length of stay.

Colchicine for Prevention of Atrial Fibrillation after Cardiac Surgery in the Early Postoperative Period.

Background. Postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery. It has been proven to be associated with an increase in the incidence of early complications and mortality, an increase in the rate of hospital stay duration, and economic costs of their treatment. One of the pharmaceutical drugs recommended by the American College of Cardiology (ACC)/American Heart Association (AHA) for preventing POAF is colchicine (class IIB). However, the results of research on the efficacy and safety of colchicine are ambiguous and, consequently, require further study. Objective. Evaluating the efficacy of short-term colchicine administration in the prevention of POAF in patients after open-heart surgery. Materials and methods. Double-blind, randomized, placebo-controlled clinical trial. The subjects were randomly assigned to two groups: treatment group (n = 50) with subjects receiving 1 mg of colchicine 24 h before the surgery, as well as on days 2, 3, 4, and 5 in the postoperative period; and the control group (n = 51), receiving placebo on the same schedule. The primary endpoint was the frequency of POAF in both groups within 7 days after surgery. Results. The study included 101 patients (82 men, 19 women). Baseline clinical, laboratory, instrumental, and intraoperative data did not differ statistically significantly between the groups. POAF was detected in 9 patients (18%) of the treatment group and 15 subjects (29.4%) of the control group, which had no statistical significance (odds ratio, OR 0.527; 95% Cl 0.206–1.349; p = 0.178). No statistically significant differences were revealed for most secondary endpoints, as well as between the groups for all laboratory parameters. There were statistically significant differences between the groups solely in the frequency of diarrhea: 16 (32%) patients in the treatment group and 6 (11.8%) subjects in the control group (OR 3.529; 95% Cl 1.249–9.972; p = 0.010). Conclusions. We did not detect any statistical differences between the groups in terms of primary endpoints, which could be due to the insufficient volume of the sample of the study. However, we detected some trends of statistical differences among the groups in terms of some parameters. Clinical Trials Registration. ClinicalTrials. Unique identifier: NCT04224545.

Effect of Omega-3 Polyunsaturated Fatty Acid on the Prevention of Atrial Fibrillation after Off-Pump Coronary Artery Bypass Grafting

Background: Postoperative atrial fibrillation (POAF) often occurs in patients after coronary artery bypass graft surgery (CABG), both conventional and off pump ranges from 11% to 40%. Although often transient, self-limited, and benign, it may be associated with increased postoperative morbidity. The prevention of POAF has been associated with improved postoperative outcomes in terms of reduced medical treatment, laboratory tests, shorter nursing time, and hospital stay, even when uncomplicated. The present study was conducted to find out the effect of omega polyunsaturated fatty acid on the prevention of POAF after off pump CABG.&#x0D; Method: This cross-sectional study was conducted in the Department of Cardiac Surgery, National Institute of Cardiovascular Diseases (NICVD), Sher-E-Bangla Nagar, Dhaka, between September 2017 and August 2018. Total 100 patients with sinus rhythm admitted for OPCAB were included in this study, and they were divided into two groups, Group A, 50 patients having omega-3 PUFA in the preoperative and postoperative period up to the fifth postoperative day (POD) and Group B, 50 patients not having omega-3 PUFA in the preoperative and postoperative period up to the fifth POD. Findings were compared between two groups preoperatively, postoperatively, up to 5 days, at discharge, and at one month after discharge.&#x0D; Results: Postoperative AF was significantly higher in group B in comparison to group A up to 5th POD. AF was present in a few patients during discharge and one month after discharge, but the differences were statistically not significant between groups. Total ICU stay was similar between the two groups, but the postoperative hospital stay was shorter in Group A, and the mean difference was statistically significant.&#x0D; Conclusion: This study concluded that perioperative oral omega-3 polyunsaturated fatty acid intake reduces the incidence of postoperative atrial fibrillation in patients undergoing off pump coronary artery bypass graft surgery.&#x0D; University Heart Journal 2022; 18(1): 36-43

Abstract 12351: Perioperative Interventions for Prevention of Postoperative Atrial Fibrillation After Cardiac Surgery: A Systematic Review and Network Meta-Analysis

Background: Postoperative atrial fibrillation (POAF) is the most common complication of cardiac surgery, which increases the risk of stroke and death, the length of hospital stays, and costs. Guidelines recommendations on the use of β-blockers (BBs) have only a modest influence on overall rates of POAF. The key clinical outcomes such as stroke and death have not been improved. The best approach to prophylaxis remains obscure. Method: We used Bayesian network meta-analysis to synthesize evidences from randomized controlled trials (RCTs) that compared interventions for POAF prophylaxis. The primary outcomes were incidence of POAF hypotension and bradycardia. Results: We included 262 RCTs with 52636 participants (age &gt; 18, undergoing CABG, valvular or combined surgery), in which 14 different interventions were investigated. For the incidence of POAF, sotalol, amiodarone, BBs, posterior pericardiotomy, atrial pacing, magnesium, polyunsaturated fatty acids, colchicine, glucocorticoid and statin had positive results compared to placebo with statistical significance. The best three therapeutics were sotalol (OR 0.29, 95% CI 0.21-0.41; probability of being best 84.6%), amiodarone (OR 0.39, 95% CI 0.31-0.48) and BBs (OR 0.39, 95% CI 0.31-0.49). For safety, BBs (OR 4.09, 95% CI 2.10-7.96), magnesium (OR 2.51, 95% CI 1.09-5.76) and sotalol (OR 2.07, 95% CI 1.06-4.05) were associated with higher incidence of hypotension. Sotalol (OR 2.80, 95% CI 1.66-4.74) and amiodarone (OR 2.27, 95% CI 1.66-3.10) were associated with higher incidence of bradycardia. For secondary outcomes, no significant effect on all-cause or cardiovascular mortality was observed. Amiodarone was the only intervention that reduced stroke rate (OR 0.57, 95% CI 0.34-0.96). Conclusions: Sotalol appeared to be superior in efficiency compared with others. BBs do not work as well as we expected with the highest incidence of hypotension.Further studies are required to define the better interventions

A short cut to prevent postoperative atrial fibrillation

Postoperative atrial fibrillation is a common complication of cardiac surgery and increases the risk of mortality, stroke, morbidity, and extended stay in hospital. 1 Hindricks G Potpara T Dagres N et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021; 42: 373-498 Crossref PubMed Scopus (2081) Google Scholar , 2 Greenberg JW Lancaster TS Schuessler RB Melby SJ Postoperative atrial fibrillation following cardiac surgery: a persistent complication. Eur J Cardiothorac Surg. 2017; 52: 665-672 Crossref PubMed Scopus (125) Google Scholar , 3 Arsenault KA Yusuf AM Crystal E et al. Interventions for preventing post-operative atrial fibrillation in patients undergoing heart surgery. Cochrane Database Syst Rev. 2013; 2013CD003611 Google Scholar Although other researchers have shown, mostly in small studies and meta-analyses, 4 Gozdek M Pawliszak W Hagner W et al. Systematic review and meta-analysis of randomized controlled trials assessing safety and efficacy of posterior pericardial drainage in patients undergoing heart surgery. J Thorac Cardiovasc Surg. 2017; 153: 865-875.e12 Summary Full Text Full Text PDF PubMed Scopus (24) Google Scholar that this simple surgical procedure reduces the risk of cardiac tamponade, a randomised comparison between posterior left pericardiotomy and standard of care, with postoperative atrial fibrillation as a primary outcome measure, had not been performed until now. 5 Abouarab AA Leonard JR Ohmes LB et al. Posterior left pericardiotomy for the prevention of postoperative Atrial fibrillation after Cardiac Surgery (PALACS): study protocol for a randomized controlled trial. Trials. 2017; 18: 593 Crossref PubMed Scopus (9) Google Scholar In The Lancet, Mario Gaudino and colleagues 6 Gaudino M Sanna T Ballman KV et al. Posterior left pericardiectomy for the prevention of atrial fibrillation after cardiac surgery: an adaptive, single-centre, single-blind, randomised, controlled trial. Lancet. 2021; (published online Nov 14.)https://doi.org/10.1016/S0140-6736(21)02490-9 Summary Full Text Full Text PDF PubMed Scopus (13) Google Scholar report their randomised controlled trial investigating this procedure to fill this knowledge gap. Posterior left pericardiotomy for the prevention of atrial fibrillation after cardiac surgery: an adaptive, single-centre, single-blind, randomised, controlled trialPosterior left pericardiotomy is highly effective in reducing the incidence of atrial fibrillation after surgery on the coronary arteries, aortic valve, or ascending aorta, or a combination of these without additional risk of postoperative complications. Full-Text PDF

Design and Rationale of a Phase 2 Study of NeurOtoxin (Botulinum Toxin Type A) for the PreVention of Post-Operative Atrial Fibrillation – The NOVA Study

Post-operative AF (POAF) is the most common complication following cardiac surgery, occurring in 30% to 60% of patients undergoing bypass and/or valve surgery. POAF is associated with longer intensive care unit/hospital stays, increased healthcare utilization, and increased morbidity and mortality. Injection of botulinum toxin type A into the epicardial fat pads resulted in reduction of AF in animal models, and in two clinical studies of cardiac surgery patients, without new safety observations. The objective of NOVA is to assess the use of AGN-151607 (botulinum toxin type A) for prevention of POAF in cardiac surgery patients. This randomized, multi-site, placebo-controlled trial will study one-time injections of AGN-151607 125 U (25 U / fat pad) and 250 U (50 U / fat pad) or placebo during cardiac surgery in ∼330 participants. Primary endpoint: % of patients with continuous AF ≥ 30 s. Secondary endpoints include several measures of AF frequency, duration, and burden. Additional endpoints include clinically important tachycardia during AF, time to AF termination, and healthcare utilization. Primary and secondary efficacy endpoints will be assessed using continuous ECG monitoring for 30 days following surgery. All patients will be followed for up to 1 year for safety. The NOVA Study will test the hypothesis that injections of AGN-151607 will reduce the incidence of POAF and associated resource utilization. If demonstrated to be safe and effective, the availability of a one-time therapy for the prevention of POAF would represent an important treatment option for patients undergoing cardiac surgery.

Factors for the development of atrial fibrillation after open heart surgery

Aim. To identify the factors influencing the development of postoperative atrial fibrillation (POAF).Methods. The study included 100 patients with indications for cardiac surgery, aged 53 to 82 years (mean age 67.2±17 years). The group included patients who had no history of AF before surgery. Cardiac surgery in the group was presented in 63 patients by coronary artery bypass grafting, and in 37 – by intervention on the heart valves. All respondents were divided into 2 groups: the first included 39 people (39%) who had AF paroxysms lasting more than 30 seconds in the early postoperative period, with a peak at 1–2 days, in 13 (33.3%) cases of AF relapsed. The second group of patients was represented by 61 patients (61%) without cardiac arrhythmias after surgery.Results. The dependence of the development of POAF on age, the concentration of C-reactive protein in the peripheral blood taken on the day of cardiac surgery, the longitudinal size of the left atrium before surgery was revealed.Conclusion. It was found out that a number of factors such as age, preoperative left atrium size, C-reactive protein level in the first days after surgery suggest the development of POAF. The use of the predictors obtained can make it possible to develop an effective strategy for the prevention of POAF.

The effect of omega-3 polyunsaturated fatty acids in prevention of postoperative atrial fibrillation development in patients undergoing coronary artery bypass graft surgery

Abstract Funding Acknowledgements Type of funding sources: None. Purpose. To estimate the effect of omega-3 polyunsaturated fatty acids (PUFAs) in prevention of postoperative atrial fibrillation (POAF) in patients with coronary artery disease undergoing coronary artery bypass graft (CABG) surgery. Methods. Studied were 306 patients who underwent CABG. All the patients were divided into two groups depending on the prescription of omega-3 PUFAs in the pre- and postoperative period by randomization method: 1 group comprised 158 patients without PUFAs (82.7% men, median age 63.0 (57.0;67.0) years, 2 group - 148 patients with PUFAs (89.3% men, median age 60.0 (57.0;64.0) years). PUFAs were prescribed 2000 mg daily starting with 5 days before CABG and 1000 mg daily after CABG for 21 days. In all the patients, we studied interleukin (IL)-6, IL-8, IL-10, NT-proBNP, troponin, superoxide dismutase (SOD), malondialdehyde (MDA), glutathione and omega-3 index. Results. During the observation period POAF occurred in 29.7% patients of group 1, and in 16.9% patients of group 2 (p = 0.009). In postoperative period patients of group 1 had median IL-6 level 39.3% higher (p = 0.001) and median IL-10 level - 20.2% higher (p = 0.01) comparing with group 2. In patients of group 2 we found SOD median level 78.9% lower (р&amp;lt;0.0001) and MDA median level 33.8% lower compared to the patients of group 1 (р=0.03). In postoperative period in group 2 the median level of docosahexaenoic acid was 55% higher (p = 0.03), and omega-3 index - 43.4% higher (h = 0.04) compared with group 1. Conclusion. We found that patients with PUFAs had less activation of inflammation and oxidative stress after CABG than patients without PUFAs. The patients with PUFAs also had increased levels of docosahexaenoic acids and omega-3 index compared to the patients without PUFAs. We also found a significant decrease of the prevalence of POAF after CABG in patients with PUFAs.

Effects of corticosteroids on new-onset atrial fibrillation after cardiac surgery: A meta-analysis of randomized controlled trials.

Background:Postoperative atrial fibrillation (POAF) occurs commonly after cardiac surgery. Studies suggest that corticosteroid can reduce the incident of POAF. However, the results remain controversial. This meta-analysis aimed to evaluate the efficacy and safety corticosteroid on the prevention of POAF following cardiac surgery.Methods:Randomized controlled trials were identified through a systematic literature search. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. Primary outcome was the incidence of POAF as well as length of hospital stay and intensive care unit stay, wound and other infection, mortality, duration of ventilation, myocardial infarction, gastrointestinal complications, high blood sugar, stroke, and postoperative bleeding.Results:Fourteen studies with 13,803 patients were finally involved in the present study. Overall, corticosteroid significantly decreased the risk of POAF (relative risk [RR], 0.7; 95% confidence interval [CI], 0.55–0.89; P = .003). There were no significant differences in the incidence of length of intensive care unit stay (RR, −2.32; 95% CI, −5.44 to 0.80; P = .14) and hospital stay (RR, −0.43; 95% CI, −0.84 to −0.02; P = .04), infections (RR, 1.01; 95% CI, 0.83–1.23; P = .9), mortality (RR, 0.87; 95% CI, 0.71–1.06; P = .16), duration of ventilation (RR, −0.29; 95% CI, −0.65 to 0.07; P = .12), gastrointestinal complications (RR, 1.26; 95% CI, 0.91–1.76; P = .16), high blood sugar (RR, 1.98; 95% CI, 0.91–4.31; P = .09), stroke (RR, 0.9; 95% CI, 0.69–1.18; P = .45), postoperative bleeding (RR −44.54; 95% CI, −115.28 to 26.20; P = .22) and myocardial infarction (RR, 1.71; 95% CI, 0.96–1.43; P = .12).Conclusion:Our review suggests that the efficacy of corticosteroid might be beneficial to POAF development in patients undergoing cardiac surgery. The strength of this association remains uncertain because of statistical and clinical heterogeneity among the included studies.

Local Use of Hydrogel with Amiodarone in Cardiac Surgery: Experiment and Translation to the Clinic.

The objective of this study was to study the use of the hydrogel biopolymer based on sodium alginate (“Colegel”) with a drug substance—amiodarone—for the prevention of postoperative atrial fibrillation (POAF) in cardiac surgery. The experimental part of the study was performed on 46 rabbits. Five groups were formed: in the first group, the dose of amiodarone in hydrogel was 1 mg; in the second group—3 mg; in the third group—6 mg; in the fourth group, hydrogel was used without amiodarone; in the fifth group, 60 mg amiodarone was administered intravenously. The animals from each group were removed from the experiment for the pathomorphological study of the heart after 3, 7 and 14 days. The studied endpoints were: the heart rate control; the development of the blockades of the conduction system of the heart; and the development of inflammation according to laboratory pathomorphological studies. The translational clinical part involved a randomized clinical trial which included 60 patients, with an average age of 62 ± 8.5 years. All patients were randomized into two groups: the study group (n = 30, with the application of amiodarone hydrogel) and the control group (n = 30, without the application of amiodarone hydrogel). The dose of amiodarone in the hydrogel material was 60 mg for all patients. The heart rhythm was monitored during 5 days. The primary endpoint was the development of POAF. Secondary endpoints were: the dynamics of heart rate; the duration of the QT and PQ intervals; the development of blockades of the cardiac conduction system; as well as the dynamics of AST and ALT. According to the results of the experimental part, it was found that the method of the local epicardial delivery of amiodarone by the hydrogel material was safe. Hydrogel with amiodarone is effective for reducing the heart rate in the animal experiment in comparison to the control group and the group with the intravenous administration of the drug. The optimal dose of amiodarone in hydrogel was 1 mg per 1 kg. According to the results of the clinical part, it was found that the method of the local epicardial delivery of amiodarone as a hydrogel material proved its safety. Hydrogel with amiodarone at a dose of 60 mg was effective in preventing POAF in patients after coronary artery bypass grafting (CABG) operations in comparison to the control group (p < 0.001). The age and procedure of application of the amiodarone gel were significantly associated with POAF (p = 0.009 and p = 0.011, respectively). The use of hydrogel with amiodarone reduced the probability of developing POAF 18.9-fold. The method of the local epicardial delivery of amiodarone in the form of a hydrogel material is safe. The use of hydrogel with amiodarone after CABG reduced the probability of developing POAF.

L-Carnitine supplementation for the prevention of postoperative atrial fibrillation in aortic valve surgery.

L-Carnitine, a quaternary amine, improves fatty acid metabolism in the heart and has anti-inflammatory effects. Several studies have reported the efficacy of L-carnitine for the prophylaxis of arrhythmia. We assessed the clinical effectiveness of L-carnitine in preventing postoperative atrial fibrillation (POAF) in aortic valve surgery. Thirty patients who underwent aortic valve surgery were included. Fifteen patients had no prophylaxis other than conventional measures (control), while 15 patients received oral L-carnitine for 9days (daily dose of 3g). The incidence of POAF during 1week after surgery was compared between the two groups. The multivariable logistic regression analysis for POAF was performed using the pre- and intraoperative parameters. Preoperative characteristics and operative data were comparable between the groups. The POAF rate was significantly lower in the L-carnitine group than in the control (20% and 60%, respectively; P = 0.025). L-Carnitine use was an independently negative predictor for POAF (odds ratio 0.067; 95% confidence interval 0.006-0.768). L-Carnitine administration may have potential for the prevention of POAF in aortic valve surgery.

Statin Therapy in Post-Operative Atrial Fibrillation: Focus on the Anti-Inflammatory Effects.

Background: Atrial fibrillation (AF) occurring after cardiac surgery, post-operative AF (POAF), is a serious and common complication of this treatment. POAF may be life-threatening and the available preventive strategies are insufficient or are associated with significantly increased risk of adverse effects, especially in long-term use. Therefore, more appropriate treatment strategies are needed. Methods: In this paper, the efficacy, safety, and other aspects of using statins in the prevention of POAF focusing on their anti-inflammatory effects are reviewed. Results: Recent studies have suggested that inflammation has a significant role in POAF, from the first AF episode to its serious complications including stroke and peripheral embolism. On the other hand, statins, the most widely used medications in cardiovascular patients, have pleiotropic effects, including anti-inflammatory properties. Therefore, they may potentially be effective in POAF prevention. Statins, especially atorvastatin, appear to be an effective option for primary prevention of POAF, especially in patients who had coronary artery bypass grafting (CABG), a cardiac surgery treatment associated with inflammation in the heart muscle. However, several large studies, particularly with rosuvastatin, did not confirm the beneficial effect of statins on POAF. One large clinical trial reported higher risk of acute kidney injury (AKI) following high-dose rosuvastatin in Chinese population. In this study, rosuvastatin reduced the level of C-reactive protein (CRP) but did not reduce the rate of POAF. Conclusion: Further studies are required to find the most effective statin regimen for POAF prevention with the least safety concern and the highest health benefits.

Landiolol hydrochloride for the prevention of postoperative atrial fibrillation in patients undergoing oesophagectomy: a pilot trial sequential analysis of randomised trials for hypothesis synthesis

Introduction: Postoperative atrial fibrillation (AF) after oesophagectomy is associated with pulmonary and anastomotic complications. Landiolol hydrochloride is an ultrashort-acting β1-selective blocker that may prevent AF via its anti-inflammatory and β1-adrenergic blockade effects. We aimed to perform a pilot systematic review, meta-analysis and trial sequential analysis of randomised trials to assess the level of current evidence for hypothesis synthesis.