Intraoperative Factors Cause Postoperative Atrial Fibrillation?

To the Editor:

We read the study by Takahashi et al¹ with great interest. When we reviewed the predictor factors for postoperative atrial fibrillation (POAF) in this study, we did not find any data clearing basic intraoperative factors like systemic inflammatory response and oxidative stress triggered by extracorporeal circulation.^2,3 Proinflammatory mediators triggered by extracorporeal circulation and cross-clamping mediate depression of cardiac functions and apoptosis, along with ischemia-reperfusion injury.^2–4 Arrhythmias are facilitated by these structural and humoral changes in cardiac muscle.² In this study, however, it is very intriguing that Takahashi et al did not find a significant difference for POAF in the 2 groups when they analyzed extracorporeal circulation and cross-clamp time. In a similar study by the same authors, in which they used patients with aortic valve replacement, they found no significant difference for POAF in groups for the same parameters.⁵ We are wondering if they used any anti-inflammatory agents in the priming solution or during cardiopulmonary bypass via peripheral administration. We would deeply appreciate if the authors explain this matter.

• Orhan Gokalp, MD
• Bortecin Eygi, MD
• Yuksel Besir, MD
• Gamze Gokalp, MD
• Ali Gurbuz, MD
• Department of Cardiovascular Surgery, Faculty of Medicine (O.G., A.G.),
• Department of Cardiovascular Surgery, Ataturk Education and Research Hospital (B.E., Y.B.),
• Izmir Katip Celebi University, Izmir;
• Department of Pediatric Emergency, Tepecik Education and Research Hospital, Izmir (G.G.), Turkey

(Released online March 3, 2016)

References

• 1.    Takahashi  S,  Katayama  K,  Watanabe  M,  Kodama  H,  Taguchi  T,  Kurosaki  T, et al. Preoperative tissue Doppler imaging-derived atrial conduction time predicts postoperative atrial fibrillation in patients undergoing mitral valve surgery for mitral valve regurgitation. Circ J 2016; 80: 101–109.
• 2.    Zakkar  M,  Ascione  R,  James  AF,  Angelini  GD,  Suleiman  MS. Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery. Pharmacol Ther 2015; 154: 13–20.
• 3.    Qu  C,  Wang  XW,  Huang  C,  Qiu  F,  Xiang  XY,  Lu  ZQ. High mobility group box 1 gene polymorphism is associated with the risk of postoperative atrial fibrillation after coronary artery bypass surgery. J Cardiothorac Surg 2015 June 25, doi:10.1186/s13019-015-0301-2.
• 4.    Wang  M,  Baker  L,  Tsai  BM,  Meldrum  KK,  Meldrum  DR. Sex differences in the myocardial inflammatory response to ischemia-reperfusion injury. Am J Physiol Endocrinol Metab 2005; 288: 321–326.
• 5.    Takahashi  S,  Fujiwara  M,  Watadani  K,  Taguchi  T,  Katayama  K,  Takasaki  T, et al. Preoperative tissue Doppler imaging-derived atrial conduction time can predict postoperative atrial fibrillation in patients undergoing aortic valve replacement for aortic valve stenosis. Circ J 2014; 78: 2173–2181.