Download PDF
Thorac Cardiovasc Surg 2023; 71(04): 291-296
DOI: 10.1055/s-0042-1750787
Original Cardiovascular

Atrial Fibrillation after Coronary Bypass Surgery? Is Epicardial Fat a Risk Factor?

Adnan Yalçınkaya 
1   Department of Cardiovascular Surgery, Hitit University Faculty of Medicine, Corum, Turkey
,
Nurdan Fidan
2   Department of Radiology, Hitit University Faculty of Medicine, Corum, Turkey
,
Engin Sarı
2   Department of Radiology, Hitit University Faculty of Medicine, Corum, Turkey
,
Sertan Özyalçın
1   Department of Cardiovascular Surgery, Hitit University Faculty of Medicine, Corum, Turkey
,
Adem İlkay Diken
1   Department of Cardiovascular Surgery, Hitit University Faculty of Medicine, Corum, Turkey
› Author Affiliations
› Further Information
    Permissions and Reprints All articles of this category

Abstract

Backgrounds Postoperative atrial fibrillation (POAF) is one of the most common complication of cardiac surgery. Epicardial fat tissue may play a role in the development of atrial fibrillation (AF). The aim of this study was to evaluate relationship between epicardial fat volume (EFV) and the appearance of new-onset AF in patients undergoing isolated coronary artery bypass graft (CABG) with normal echocardiographic functions.

Methods Between January 2017 and June 2020, 281 coronary artery disease patients undergone isolated CABG surgery with normal echocardiographic functions were included in the study. Patient characteristics, medical history, and perioperative variables were retrospectively collected. Patients with AF predisposition factors were excluded.

Results Sixty-seven patients (23.8%) developed postoperatively AF during hospital stay. In univariate analysis, patients with postoperative AF were older compared with sinus rhythm patients (60.78 ± 9.03 vs. 65.46 ± 9.22, p = 0.001). There are no statistically significant differences between groups and EFV compared (107.78 ± 41.04 vs. 106.66 ± 34.98 p = 0.84). Large left atrial diameter, female patient, cardiopulmonary bypass and longer cross-clamp time showed correlation between POAF without statistical significance.

Conclusion Aging is the only associated factor with AF in this study. There was no EFV difference between POAF and non-AF groups in patients undergoing isolated CABG with normal echocardiographic functions.

Keywords

coronary artery bypass grafts surgery - CABG - arrhythmia therapy - cardiac anatomy/pathologic anatomy


Publication History

Received: 08 December 2021

Accepted: 14 April 2022

Article published online:
27 July 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Echahidi N, Pibarot P, O'Hara G, Mathieu P. Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery. J Am Coll Cardiol 2008; 51 (08) 793-801
    CrossrefPubMedSearch in Google Scholar
  • 2 Bharucha DB, Kowey PR. Management and prevention of atrial fibrillation after cardiovascular surgery. Am J Cardiol 2000; 85 (10A): 20D-24D
    CrossrefPubMedSearch in Google Scholar
  • 3 Aranki SF, Shaw DP, Adams DH. et al. Predictors of atrial fibrillation after coronary artery surgery. Current trends and impact on hospital resources. Circulation 1996; 94 (03) 390-397
    CrossrefPubMedSearch in Google Scholar
  • 4 Jakubová M, Mitro P, Stančák B. et al. The occurrence of postoperative atrial fibrillation according to different surgical settings in cardiac surgery patients. Interact Cardiovasc Thorac Surg 2012; 15 (06) 1007-1012
    CrossrefPubMedSearch in Google Scholar
  • 5 Nakai T, Chandy J, Nakai K. et al. Histologic assessment of right atrial appendage myocardium in patients with atrial fibrillation after coronary artery bypass graft surgery. Cardiology 2007; 108 (02) 90-96
    CrossrefPubMedSearch in Google Scholar
  • 6 Mathew JP, Fontes ML, Tudor IC. et al; Investigators of the Ischemia Research and Education Foundation, Multicenter Study of Perioperative Ischemia Research Group. A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA 2004; 291 (14) 1720-1729
    CrossrefPubMedSearch in Google Scholar
  • 7 Sezai A, Hata M, Niino T. et al. 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. J Thorac Cardiovasc Surg 2009; 137 (04) 895-900
    CrossrefPubMedSearch in Google Scholar
  • 8 Hogue Jr. CW, Hyder ML. Atrial fibrillation after cardiac operation: risks, mechanisms, and treatment. Ann Thorac Surg 2000; 69 (01) 300-306
    CrossrefPubMedSearch in Google Scholar
  • 9 Polanczyk CA, Goldman L, Marcantonio ER, Orav EJ, Lee TH. Supraventricular arrhythmia in patients having noncardiac surgery: clinical correlates and effect on length of stay. Ann Intern Med 1998; 129 (04) 279-285
    CrossrefPubMedSearch in Google Scholar
  • 10 Eiras S, Teijeira-Fernández E, Salgado-Somoza A. et al. Relationship between epicardial adipose tissue adipocyte size and MCP-1 expression. Cytokine 2010; 51 (02) 207-212
    CrossrefPubMedSearch in Google Scholar
  • 11 Caprio M, Antelmi A, Chetrite G. et al. Antiadipogenic effects of the mineralocorticoid receptor antagonist drospirenone: potential implications for the treatment of metabolic syndrome. Endocrinology 2011; 152 (01) 113-125
    CrossrefPubMedSearch in Google Scholar
  • 12 Fei J, Cook C, Blough E, Santanam N. Age and sex mediated changes in epicardial fat adipokines. Atherosclerosis 2010; 212 (02) 488-494
    CrossrefPubMedSearch in Google Scholar
  • 13 Baker AR, Silva NF, Quinn DW. et al. Human epicardial adipose tissue expresses a pathogenic profile of adipocytokines in patients with cardiovascular disease. Cardiovasc Diabetol 2006; 5: 1
    CrossrefPubMedSearch in Google Scholar
  • 14 Iacobellis G, Pistilli D, Gucciardo M. et al. Adiponectin expression in human epicardial adipose tissue in vivo is lower in patients with coronary artery disease. Cytokine 2005; 29 (06) 251-255
    PubMedSearch in Google Scholar
  • 15 Wong CX, Abed HS, Molaee P. et al. Pericardial fat is associated with atrial fibrillation severity and ablation outcome. J Am Coll Cardiol 2011; 57 (17) 1745-1751
    CrossrefPubMedSearch in Google Scholar
  • 16 Al Chekakie MO, Welles CC, Metoyer R. et al. Pericardial fat is independently associated with human atrial fibrillation. J Am Coll Cardiol 2010; 56 (10) 784-788
    CrossrefPubMedSearch in Google Scholar
  • 17 Thanassoulis G, Massaro JM, O'Donnell CJ. et al. Pericardial fat is associated with prevalent atrial fibrillation: the Framingham Heart Study. Circ Arrhythm Electrophysiol 2010; 3 (04) 345-350
    CrossrefPubMedSearch in Google Scholar
  • 18 Diken Aİ, Yalçınkaya A, Özyalçın S. Distribution of thoracic aortic calcifications in patients undergoing coronary artery bypass grafting. Aorta (Stamford) 2017; 5 (05) 132-138
    Thieme ConnectPubMedSearch in Google Scholar
  • 19 Shen J, Lall S, Zheng V, Buckley P, Damiano Jr. RJ, Schuessler RB. The persistent problem of new-onset postoperative atrial fibrillation: a single-institution experience over two decades. J Thorac Cardiovasc Surg 2011; 141 (02) 559-570
    CrossrefPubMedSearch in Google Scholar
  • 20 Perrier S, Meyer N, Hoang Minh T. et al. Predictors of atrial fibrillation after coronary artery bypass grafting: a Bayesian analysis. Ann Thorac Surg 2017; 103 (01) 92-97
    CrossrefPubMedSearch in Google Scholar
  • 21 Opolski MP, Staruch AD, Kusmierczyk M. et al. Computed tomography angiography for prediction of atrial fibrillation after coronary artery bypass grafting: proof of concept. J Cardiol 2015; 65 (04) 285-292
    CrossrefPubMedSearch in Google Scholar
  • 22 Drossos G, Koutsogiannidis CP, Ananiadou O. et al. Pericardial fat is strongly associated with atrial fibrillation after coronary artery bypass graft surgery. Eur J Cardiothorac Surg 2014; 46 (06) 1014-1020 , discussion 1020
    CrossrefPubMedSearch in Google Scholar
  • 23 Mitchell LB. CCS Atrial Fibrillation Guidelines Committee. Canadian Cardiovascular Society atrial fibrillation guidelines 2010: prevention and treatment of atrial fibrillation following cardiac surgery. Can J Cardiol 2011; 27 (01) 91-97
    CrossrefPubMedSearch in Google Scholar
  • 24 Athanasiou T, Aziz O, Mangoush O. et al. Does off-pump coronary artery bypass reduce the incidence of post-operative atrial fibrillation? A question revisited. Eur J Cardiothorac Surg 2004; 26 (04) 701-710
    CrossrefPubMedSearch in Google Scholar
  • 25 Lewicki Ł, Siebert J, Rogowski J. Atrial fibrillation following off-pump versus on-pump coronary artery bypass grafting: Incidence and risk factors. Cardiol J 2016; 23 (05) 518-523
    PubMedSearch in Google Scholar
  • 26 Mazurek T, Zhang L, Zalewski A. et al. Human epicardial adipose tissue is a source of inflammatory mediators. Circulation 2003; 108 (20) 2460-2466
    CrossrefPubMedSearch in Google Scholar
  • 27 Iacobellis G, Corradi D, Sharma AM. Epicardial adipose tissue: anatomic, biomolecular and clinical relationships with the heart. Nat Clin Pract Cardiovasc Med 2005; 2 (10) 536-543
    CrossrefPubMedSearch in Google Scholar
  • 28 Greif M, von Ziegler F, Wakili R. et al. Increased pericardial adipose tissue is correlated with atrial fibrillation and left atrial dilatation. Clin Res Cardiol 2013; 102 (08) 555-562
    CrossrefPubMedSearch in Google Scholar
  • 29 Zhu W, Zhang H, Guo L, Hong K. Relationship between epicardial adipose tissue volume and atrial fibrillation: a systematic review and meta-analysis. Herz 2016; 41 (05) 421-427
    CrossrefPubMedSearch in Google Scholar
  • 30 Kogo H, Sezai A, Osaka S, Shiono M, Tanaka M. Does epicardial adipose tissue influence postoperative atrial fibrillation?. Ann Thorac Cardiovasc Surg 2019; 25 (03) 149-157
    CrossrefPubMedSearch in Google Scholar
  • 31 Mahabadi AA, Lehmann N, Kälsch H. et al. Association of epicardial adipose tissue and left atrial size on non-contrast CT with atrial fibrillation: the Heinz Nixdorf Recall Study. Eur Heart J Cardiovasc Imaging 2014; 15 (08) 863-869
    CrossrefPubMedSearch in Google Scholar
  • 32 Park J, Park CH, Lee HJ. et al. Left atrial wall thickness rather than epicardial fat thickness is related to complex fractionated atrial electrogram. Int J Cardiol 2014; 172 (03) e411-e413
    CrossrefPubMedSearch in Google Scholar