Characterisation and validity of inflammatory biomarkers in the prediction of post-operative atrial fibrillation in coronary artery disease patients.

Atrial fibrillation (AF) is a common complication of coronary artery bypass grafting (CABG). We sought to determine the diagnostic validity of plasma biomarkers of i) inflammation (marked by interleukin-6 [IL-6] and high-sensitivity C-reactive protein [hs-CRP]), ii) extracellular matrix remodelling (matrix metalloproteinase [MMP-9], tissue inhibitor of matrix metalloproteinase [TIMP-1]) and iii) the prothrombotic state (tissue factor and von Willebrand factor [vWF]) in the risk prediction of post-operative AF. Samples were obtained preoperatively from peripheral/femoral vein and from intracardiac chambers (right atrium [RA], the right atrial appendage [RAA], the left atrium [LA] and the left atrial appendage [LAA]) amongst 100 consecutive patients free of AF and inflammatory disease undergoing elective CABG. Biomarker concentrations were related to incident AF (30 days). At 30 days post CABG, 30 patients were proven to have had AF. Concentrations of tissue factor (TF) and vWF were unrelated to postoperative AF. Peripheral (p=0.018), and intracardiac levels (RAA (p=0.029) and LA (p=0.026)) of hs-CRP were associated with the presence of AF after CABG. Intracardiac levels of IL-6 in samples from the RAA (p=0.031), LA (p=0.042) and LAA (p=0.006), and MMP-9 in the LAA sample were also associated with AF (p=0.007). Our data suggest that an intra-cardiac inflammatory environment that is manifest peri-operatively may predispose to the development of post-operative AF. This intracardiac inflammatory state was reflected by increased peripheral hs-CRP levels. These differences may indicate local substrate abnormalities contributing to the development of AF post-operatively.

[Factors influencing development of atrial fibrillation after implantation of cardiac pacemaker for sinus node dysfunction]. / Besikartojanciam priesirdziu virpejimui itakos turintys veiksniai, esant sinusinio mazgo disfunkcijai, koreguotai implantavus pastovu elektrokardiostimuliatoriu.

OBJECTIVE: The aim of this study was to evaluate factors influencing the success of atrial fibrillation treatment associated with the sick sinus syndrome after pacemaker implantation. METHODS AND RESULTS: In 163 patients with sick sinus syndrome followed up after pacemaker implantation, statistical analysis showed that the recurrence of atrial fibrillation increased 2.8 times and 2.5 times when the left atrium or the right atrium, respectively, were increased by 1 cm (P=0.001). In addition, the recurrence of atrial fibrillation increased 2.5 times when the interventricular septum was thickened (P=0.007). Probability of atrial fibrillation recurrence was 2.73 times higher in the presence of grade II mitral regurgitation as compared to absent or grade I mitral regurgitation (P=0.029). The results of atrial fibrillation treatment did not significantly depend on age, gender, duration of atrial fibrillation symptoms, other cardiac structural changes, and concomitant noncardiac diseases. CONCLUSIONS: In patients with sick sinus syndrome, the effectiveness of atrial fibrillation treatment after pacemaker implantation is influenced by enlargement of the left and the right atria, increased interventricular septum thickness, and grade II mitral regurgitation. Evaluation of echocardiographic data before pacemaker implantation has prognostic value for determining the probability of maintenance of sinus rhythm.

Atrial fibrillation following cardiac surgery: clinical features and preventative strategies.

Atrial fibrillation (AF) is a common complication of cardiac surgery, with an increasing incidence. Post-operative AF results in many complications and increased healthcare resources. Despite substantial interest in the prediction and prevention of post-operative AF, as well as guidelines for the management of this common arrhythmia, there is still some uncertainty about appropriate risk stratification and management. The aim of this review article is to provide an overview of clinical predictive features for the development of AF following cardiac surgery and suitable preventive measures, using both antiarrhythmic and non-antiarrhythmic strategies.

Blood oxygen saturation during atrio-ventricular dissociation with wide-QRS complex tachycardias.

Amplitude ratios of two adjacent mixed blood oxygen saturation curve peaks in randomly selected strips of ECG were analysed in 32 patients with regular wide-QRS complex tachycardias and 60 control subjects where pacing was performed before ablation of narrow-QRS complex tachycardias. Patients with VT showed different patterns of A-to-V relationships, leading to varying ratios of SpO2 adjacent peak amplitudes, in contrast to patients with aberrant SVTs and 1:1 AV association. Application of a criterion of adjacent SpO2 peaks differing by twofold or more had a sensitivity of 90.0% and specificity of 83.3% to detect AV dissociation during VT. Fluctuations on the mixed oxygen saturation curve may be a useful non-invasive clinical parameter to detect different ventricular filling caused by atrio-ventricular dissociation during VT.