Title:Inflammation, Atrial Fibrillation and Cardiac Surgery: Current Medical and Invasive Approaches for the Treatment of Atrial Fibrillation
Volume: 24
Issue: 3
Author(s): Sahin Iscan*, Bortecin Eygi, Yuksel Besir, Ismail Yurekli, Habib Cakir, Levent Yilik, Orhan Gokalp and Ali Gurbuz
Affiliation:
- Department of Cardiovascular Surgery, Katip Celebi University Izmir Ataturk Training and Research Hospital, Izmir,Turkey
Keywords:
Inflammation, atrial fibrillation, cardiac surgery, low arterial pressure, cardiopulmonary bypass, cardiac dysrhythmia.
Abstract: Atrial fibrillation (AF) is a cardiac dysrhythmia commonly seen in clinical practice especially after
cardiac surgery. It is associated with increased morbidity and mortality for the patients. The pathogenesis of AF is
not exactly understood yet, but there is growing data about the relationship between AF and inflammation. Cardiac
surgery itself is a big source for inflammation. It causes major surgical trauma, ischemia/reperfusion injury,
hypothermia, low arterial pressure, and the equipment of cardiopulmonary bypass makes a large foreign surface
thus it activates inflammatory response. There is a large number of data about the treatment options of AF and
there are also strategies, which are related to reduction of inflammatory activation during cardiopulmonary bypass.
In order to review the relationship between cardiac surgery, inflammation, AF and treatment strategies in
patients with AF, we conducted a search through Pubmed for articles in English using the keywords: “atrial
fibrillation, cardiac surgery, inflammation, medical therapy, surgical therapy, ablation therapy” from January
2012 to present. We also searched separately for each alternative treatment modality on Pubmed. To identify
further articles, we also looked into related citations in review articles and commentaries. We searched thoroughly
the guidelines published by the European Society of Cardiology (2016), and the American Heart Association/
American College of Cardiology/ Heart Rhythm Surgery (2014). Many studies concluded that inflammation
contributes in the occurrence of AF. Inflammatory markers, such as CRP, interleukins and complements have
high sensitivity and specificity for prediction of AF whether the patient having cardiac surgery or not. Betablockers,
diltiazem and amiodarone are the most commonly used drugs for rate control in AF following surgery.
Although there are some new therapeutic approaches to reduce postoperative inflammatory activation, such as the
use of vitamins, fatty acids, statins, or technical improvements to cardiopulmonary bypass unit like miniaturized
bypass circuits, heparin coating of the circuits, leukocyte filters, or various surgical approaches like off-pump
coronary bypass surgery, we still need more effective strategies to reduce both postoperative inflammation and
postoperative AF risk after cardiac surgery. Today we use more advanced invasive and surgical treatment strategies
for AF although we need far more advanced technics to reduce perioperative inflammatory activation, which
actually causes AF.
