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Mitsumasa Hata
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J Thorac Cardiovasc Surg 2009;137:895-900
© 2009 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Study of the factors related to atrial fibrillation after coronary artery bypass grafting: A search for a marker to predict the occurrence of atrial fibrillation before surgical intervention

Akira Sezai, MD, PhDa,*, Mitsumasa Hata, MD, PhDa, Tetsuya Niino, MD, PhDa, Yuji Kasamaki, MD, PhDb, Toshiko Nakai, MD, PhDb, Atsushi Hirayama, MD, PhDb, Kazutomo Minami, MD, PhDa

a Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
b Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan

Received for publication March 6, 2008; revisions received August 14, 2008; accepted for publication October 3, 2008.

* Address for reprints: Akira Sezai, MD, PhD, Department of Cardiovascular Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-kamimachi Itabashi-ku Tokyo, 173-8610, Japan. (Email: asezai{at}med.nihon-u.ac.jp).

Objective: Atrial fibrillation after cardiac surgery is a frequent complication. In this study we studied various factors in addition to trying to identify a marker that would predict the potential for atrial fibrillation before surgical intervention to prevent its occurrence.

Methods: We targeted 234 cases in which isolated coronary artery bypass grafting had been performed. The items for study included age, EuroSCORE, and maximum values of creatine phosphokinase–MB, troponin I, and angiotensin II after surgical intervention and preoperative values of atrial natriuretic peptide, brain natriuretic peptide, and C-reactive protein. As fibrotic markers, we measured levels of the sialylated carbohydrate antigen KL-6 in the blood, hyaluronic acid, and pyridinoline cross-linked carboxyterminal telepeptide of type I collagen C. At the time of surgical intervention, a section of the right atrium was extracted, and atrial natriuretic peptide, the sialylated carbohydrate antigen KL-6, hyaluronic acid, and pyridinoline cross-linked telopeptide of type I collagen levels were measured.

Results: Atrial fibrillation was observed in 73 (31.2%) cases, and preoperative factors that showed statistically significant differences in the occurrence of atrial fibrillation included age, EuroSCORE, and preoperative values of atrial natriuretic peptide, angiotensin II, the sialylated carbohydrate antigen KL-6, hyaluronic acid, and pyridinoline cross-linked telopeptide of type I collagen in the blood. As for intraoperative and postoperative factors, statistically significant differences were observed in the postoperative maximum of angiotensin II, atrial natriuretic peptide of the right atrium, the sialylated carbohydrate antigen KL-6, hyaluronic acid, and pyridinoline cross-linked telopeptide of type I collagen levels.

Conclusion: The fibrosis of tissue associated with age is believed to be closely related to the occurrence of atrial fibrillation after coronary artery bypass grafting. This study suggests that the preoperative values of atrial natriuretic peptide, angiotensin II, the sialylated carbohydrate antigen KL-6, hyaluronic acid, and pyridinoline cross-linked telopeptide of type I collagen in the blood are useful as a new index for the occurrence of atrial fibrillation after coronary artery bypass grafting.

Abbreviations and Acronyms ACE-I = angiotensin-converting enzyme inhibitor; AF = atrial fibrillation; ANP = atrial natriuretic peptide; ARB = angiotensin II receptor blocker; BNP = brain natriuretic peptide; CABG = coronary artery bypass grafting; CI = confidence interval; CPB = cardiopulmonary bypass; CRP = C-reactive protein; I-CTP = pyridinoline cross-linked telopeptide of type I collagen; OR = odds ratio; RAAS = renin–angiotensin–aldosterone system






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