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Scientific letters
Perioperative serum inflammatory response and the development of atrial fibrillation after coronary artery bypass surgery
  1. J Cosgrave1,
  2. J B Foley1,
  3. R Kelly1,
  4. E McGovern2,
  5. K Bennett3,
  6. V Young2,
  7. M Tolan2,
  8. P Crean1,
  9. D Kelleher1,
  10. M J Walsh1
  1. 1Department of Cardiology, St James’s Hospital, Dublin, Ireland
  2. 2Department of Cardio-Thoracic surgery, St James’s Hospital
  3. 3Department of Pharmacology and Therapeutics, St James’s Hospital
  1. Correspondence to:
    Dr Brendan Foley
    CREST Directorate, St James’s Hospital, James’s Street, Dublin 8, Ireland; foleysecstjames.ie

https://doi.org/10.1136/hrt.2004.054262

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    Atrial fibrillation (AF) remains the most common cardiac arrhythmia and is associated with an increase in both morbidity and mortality. Some data in both the surgical and non-surgical settings suggest that inflammation has a pivotal role in the onset and propagation of AF. As on pump coronary artery bypass surgery is associated with a significant inflammatory response and an incidence of AF between 11–40%, we decided to use this model to study if there was a potential association between perioperative response and the development of postoperative AF.1,2

    PATIENTS AND METHODS

    The study was approved by the hospital ethics committee and all patients provided informed consent. This study complies with the Declaration of Helsinki. We recruited 149 non-diabetic patients undergoing first time non-emergency on pump coronary artery bypass grafting. The exclusion criteria were impaired left ventricular function (ejection fraction < 40%), renal failure (creatinine > 200 μmol/l), malignancy, chronic inflammatory conditions, and concurrent infection.

    Patients’ cardiac rhythm was monitored continuously for 72 hours after surgery, which was reviewed by a cardiologist daily. The primary end point was defined as new onset AF that persisted for at least one hour or that required urgent treatment because of instability.

    High sensitivity C reactive protein was measured by rate nephelometry with a Dade Behring apparatus. The adhesion molecules P-selectin, E-selectin, soluble intercellular adhesion molecule …

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    Footnotes

    • This work was supported by a grant from The Royal City Of Dublin Hospital trust fund.

    • There are no potential conflicts of interest.