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Histologic Assessment of Right Atrial Appendage Myocardium in Patients with Atrial Fibrillation after Coronary Artery Bypass Graft Surgery

Nakai T.a, b · Chandy J.c · Nakai K.a · Bellows W.H.d · Flachsbart K.e · Lee R.J.b · Leung J.M.c
aDivision of Cardiovascular Medicine, Nihon University School of Medicine, Tokyo, Japan; bSection of Cardiac Electrophysiology, Department of Medicine and Cardiovascular Research Institute, University of California, cDepartment of Anesthesia and Perioperative Care, University of California, Departments of dCardiovascular Anesthesiology, and eCardiovascular Surgery, Kaiser Permanente Medical Center, San Francisco, Calif., USA Cardiology 2007;108:90–96 (DOI:10.1159/000095936)


Atrial fibrillation (AF) is a common complication after coronary artery bypass graft (CABG) surgery. Despite the prevalence of AF occurring after cardiac surgery, its pathophysiology is incompletely understood. Our previous study demonstrated that age and left atrial enlargement were independent predictors of postoperative AF. Accordingly, the purpose of this study was to determine whether cellular changes such as fibrosis and/or hypertrophy occurred in the atrium in patients who subsequently developed postoperative AF. Right atrial appendage tissue was obtained during atriotomy in patients undergoing elective CABG surgery. Quantitative assessment of atrial fibrosis was performed with Sirius red stain, and atrial cell diameter was measured with the HE stain. Linear regression, t test, χ2 test or Fisher exact test were used for statistical analysis. Sixty-one patients (mean age 71 ± 8 years) were studied. Increasing age was significantly associated with fibrosis (beta 0.3, 95% CI: 0.06–0.55, p = 0.017). The amount of right atrial fibrosis tended to correlate with the incidence of postoperative AF (p = 0.08). Cell diameter was not significantly different between patients with versus without postoperative AF (p = 0.85). These results suggest that the age-related atrial fibrosis rather than cellular hypertrophy may be important in the pathogenesis of AF after CABG surgery and should be further investigated.


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