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Inflammation of Atrium After Cardiac Surgery Is Associated With Inhomogeneity of Atrial Conduction and Atrial Fibrillation
Abstract
BACKGROUND: Atrial fibrillation (AF) is common after cardiac surgery. Abnormal conduction is an important substrate for AF. We hypothesized that atrial inflammation alters atrial conduction properties. METHODS AND RESULTS: Normal mongrel canines (n=24) were divided into 4 groups consisting of anesthesia alone (control group); pericardiotomy (pericardiotomy group); lateral right atriotomy (atriotomy group); and lateral right atriotomy with antiinflammatory therapy (methylprednisolone 2 mg/kg per day) (antiinflammatory group). Right atrial activation was examined 3 days after surgery. Inhomogeneity of conduction was quantified by the variation of maximum local activation phase difference. To initiate AF, burst pacing was performed. Myeloperoxidase activity and neutrophil cell infiltration in the atrial myocardium were measured to quantify the degree of inflammation. The inhomogeneity of atrial conduction of the atriotomy and pericardiotomy groups was higher than that of the control group (2.02+/-0.10, 1.51+/-0.03 versus 0.96+/-0.08, respectively; P<0.005). Antiinflammatory therapy decreased the inhomogeneity of atrial conduction after atriotomy (1.16+/-0.10; P<0.001). AF duration was longer in the atriotomy and pericardiotomy groups than in the control and antiinflammatory groups (P=0.012). There also were significant differences in myeloperoxidase activity between the atriotomy and pericardiotomy groups and the control group (0.72+/-0.09, 0.41+/-0.08 versus 0.18+/-0.03 DeltaOD/min per milligram protein, respectively; P<0.001). Myeloperoxidase activity of the antiinflammatory group was lower than that of the atriotomy group (0.17+/-0.02; P<0.001). Inhomogeneity of conduction correlated with myeloperoxidase activity (r=0.851, P<0.001). CONCLUSIONS: The degree of atrial inflammation was associated with a proportional increase in the inhomogeneity of atrial conduction and AF duration. This may be a factor in the pathogenesis of early postoperative AF. Antiinflammatory therapy has the potential to decrease the incidence of AF after cardiac surgery.
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“This high incidence has been related to inflammatory changes in the atrial myocardium, 213 not unlike the experimental pericarditis animal models, and it may be prevented by anti-inflammatory corticosteroid or colchicine treatment.214”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [213]
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Quantitative assay for acute intestinal inflammation based on myeloperoxidase activity
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Inflammation as a risk factor for atrial fibrillation
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Mathew, J. P. (2004) · JAMA · doi:10.1001/jama.291.14.1720 · Cited by 1,234
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Atrial Fibrillation After Cardiac Surgery
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Atrial fibrillation after coronary artery bypass grafting. Is it a disorder of the elderly?
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2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation
January, C. T., Wann, L. S., Alpert, J. S., Calkins, H. G., Cigarroa, J. E., Cleveland, J. C., CONTI, J. B., Ellinor, P. T., Ezekowitz, M. D., Field, M. E., et al. (2014) · Circulation · doi:10.1161/cir.0000000000000041 · Cited by 7,145
Inflammation and the pathogenesis of atrial fibrillation
Hu, Y., Chen, Y., Lin, Y., & Chen, S. (2015) · Nature Reviews Cardiology · doi:10.1038/nrcardio.2015.2 · Cited by 1,122
Goette, A., Kalman, J. M., Aguinaga, L., Akar, J. G., Cabrera, J. Á., Chen, S. A., Chugh, S. S., Corradi, D., d’Ávila, A., Dobrev, D., et al. (2016) · Heart Rhythm · doi:10.1016/j.hrthm.2016.05.028 · Cited by 791
Goette, A., Kalman, J. M., Aguinaga, L., Akar, J. G., Cabrera, J. Á., Chen, S. A., Chugh, S. S., Corradi, D., d’Ávila, A., Dobrev, D., et al. (2016) · EP Europace · doi:10.1093/europace/euw161 · Cited by 805
Mechanisms, Prevention, and Treatment of Atrial Fibrillation After Cardiac Surgery
Echahidi, N., Pîbarot, P., O’Hara, G. E., & Mathieu, P. (2008) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.10.043 · Cited by 678
Metadata
- Authors
- Ishii, Y., Schuessler, R. B., Gaynor, S. L., Yamada, K., Fu, A. S., Boineau, J. P., & Damiano, R. J.
- Affiliations
- From the Divisions of Cardiothoracic Surgery (Y.I., R.B.S., S.L.G., A.S.F., J.P.B., R.J.D.) and Pathology (K.Y.), Washington University School of Medicine, St Louis, Mo.
- Washington University in St. Louis (US)
- ORCID
- Damiano, Ralph J.
- Venue
- Circulation
- Published
- 2005-06-07
- Volume
- 111
- Issue
- 22
- Pages
- 2881-2888
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W1994401913
- Cited by
- 319
- References
- 28
- Citations by year
- 2026: 15 · 2025: 17 · 2024: 12 · 2023: 19 · 2022: 18 · 2021: 20 · 2020: 18 · 2019: 11 · 2018: 11 · 2017: 13 · 2016: 23 · 2015: 16 · 2014: 15 · 2013: 12 · 2012: 28
- FWCI
- 5.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Heart, Lung, and Blood Institute (R01HL032257)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Keywords
- atrial fibrillation, atrial inflammation, postoperative atrial arrhythmia, cardiac surgery, pericardiotomy, right atriotomy, methylprednisolone, anti-inflammatory therapy, myeloperoxidase, neutrophil infiltration, canine model, atrial substrate, burst pacing, atrial activation
- MeSH terms
- Animals, Anti-Inflammatory Agents, Atrial Fibrillation, Dogs, Electrophysiology, Heart Atria, Heart Conduction System, Cardiac Surgical Procedures, Inflammation, Peroxidase, Postoperative Complications, Time Factors
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