Journal Mobile Options
Table of Contents
Vol. 108, No. 2, 2007
Issue release date: August 2007
Cardiology 2007;108:90–96
(DOI:10.1159/000095936)

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

Nakai T. · Chandy J. · Nakai K. · Bellows W.H. · Flachsbart K. · Lee R.J. · Leung J.M.
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

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

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.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Creswell LL, Schuessler RB, Rosenbloom M, Cox JL: Hazards of postoperative atrial arrhythmias. Ann Thorac Surg 1993;56:539–549.
  2. Mathew JP, Parks R, Savino JS, et al: Atrial fibrillation following coronary artery bypass graft surgery: predictors, outcomes, and resource utilization. Multicenter Study of Perioperative Ischemia Research Group. JAMA 1996;276:300–306.
  3. Reed GL, III, Singer DE, Picard EH, DeSanctis RW: Stroke following coronary artery bypass surgery: a case-control estimate of the risk from carotid bruits. N Engl J Med 1988;319:1246–1250.
  4. Lahtinen J, Biancari F, Salmela E, et al: Postoperative atrial fibrillation is a major cause of stroke after on-pump coronary artery bypass surgery. Ann Thorac Surg 2004;77:1241–1244.
  5. Carnes C, Chung M, Nakayama T, et al: Ascorbate attenuates atrial pacing-induced peroxynitrite formation and electrical remodeling and decreases the incidence of postoperative atrial fibrillation. Circ Res 2001;89:E32–E38.

    External Resources

  6. Gaudino M, Andreotti F, Zamparelli R, et al: The – 174G/C interleukin-6 polymorphism influences postoperative interleukin-6 levels and postoperative atrial fibrillation. Is atrial fibrillation an inflammatory complication? Circulation 2003;108(suppl II):II-195–II-199.
  7. Goette A, Juenemann G, Peters B, et al: Determinants and consequences of atrial fibrosis in patients undergoing open heart surgery. Cardiovasc Res 2002;54:390–396.
  8. Dupont E, Ko Y, Rothery S, et al: The gap-junctional protein connexin40 is elevated in patients susceptible to postoperative atrial fibrillation. Circulation 2001;103:842–849.
  9. Nakai T, Lee R, Schiller N, et al: The relative importance of left atrial function versus dimension in predicting atrial fibrillation after coronary artery bypass graft surgery. Am Heart J 2002;143:181–186.
  10. Maisch B: Ventricular remodeling. Cardiology 1996;87(suppl 1):2–10.
  11. Tamura T, Said S, Harris J, Lu W, Gerdes AM: Reverse remodeling of cardiac myocyte hypertrophy in hypertension and failure by targeting of the renin-angiotensin system. Circulation 2000;102:253–259.
  12. Titcomb CP Jr: LVH: consequences associated with cardiac remodeling. J Insur Med 2004;36:42–46.

    External Resources

  13. Harada M, Saito Y, Makagawa O, et al: Role of cardiac nonmyocytes in cyclic mechanical stretch-induced myocyte hypertrophy. Heart Vessels 1997;(suppl 12):198–200.
  14. Gerdes AM: Cardiac myocyte remodeling in hypertrophy and progression to failure. J Card Fail 2002;8(6 suppl):S264–S268.

    External Resources

  15. Frustaci A, Chimenti C, Bellocci F, Morgante E, Russo MA, Maseri A: Histological substrate of atrial biopsies in patients with lone atrial fibrillation. Circulation 1997;96:1180–1184.
  16. Ih S, Saitoh S: The histopathological substratum for atrial fibrillation in man. Acta Pathol Jpn 1982;32:183–191.
  17. Falk RH: Etiology and complications of atrial fibrillation: insights from pathology studies. Am J Cardiol 1998;82:10N–17N.

    External Resources

  18. Kawai S, Ih S, Koizumi K: Pathology of atrial fibrillation. J Cardiol 1999;33(suppl 1):47–52I.

    External Resources

  19. Ali IM, Sanalla AA, Clark V: Beta-blocker effects on postoperative atrial fibrillation. Eur J Cardiothorac Surg 1997;11:1154–1157.
  20. Frost L, Mortensen PE, Tingleff J, Platou ES, Christiansen EH, Christiansen N: Dofetilide Post-CABG Study Group. Efficacy and safety of dofetilide, a new class III antiarrhythmic agent, in acute termination of atrial fibrillation or flutter after coronary bypass surgery. Int J Cardiol 1997;58:135–140.
  21. Auer J, Weber T, Berent R, et al: Study of Prevention of Postoperative Atrial Fibrillation: A comparison between oral antiarrhythmic drugs in the prevention of atrial fibrillation after cardiac surgery: the pilot study of prevention of postoperative atrial fibrillation (SPPAF) – a randomized, placebo-controlled trial. Am Heart J. 2004;147:636–643.
  22. Kumagai K, Nakashima H, Urata H, Gondo N, Arakawa K, Saku K: Effects of angiotensin II type 1 receptor antagonist on electrical and structural remodeling in atrial fibrillation. J Am Coll Cardiol. 2003;41:2197–2204.
  23. Sideris DA, Toumanidis ST, Tselepations E, et al: Atrial pressure and experimental atrial fibrillation. Pacing Clin Electrophysiol 1995;18:1679–1685.
  24. Satoh T, Zipes DP: Unequal atrial stretch in dogs increases dispersion of refractoriness conducive to developing atrial fibrillation. J Cardiovasc Electrophysiol 1996;7:833–842.
  25. Ravelli F, Allessie M: Effects of atrial dilatation on refractory period and vulnerability to atrial fibrillation in the isolated Langendorff-perfused rabbit heart. Circulation 1997;96:1686–1695.
  26. Goette A, Staack T, Rocken C, et al: Increased expression of extracellular signal-regulated kinase and angiotensin-converting enzyme in human atria during atrial fibrillation. J Am Coll Cardiol 2000;35:1669–1677.
  27. Gottlieb SS, Dickstein K, Fleck E, et al: Hemodynamic and neurohomormonal effects of the angiotensin II antagonist losartan in patients with congestive heart failure. Circulation 1993;88:1602–1609.
  28. Nakashima H, Kumagai K, Urata H, Gondo N, Ideishi M, Arakawa K: Angiotensin II antagonist prevents electrical remodeling in atrial fibrillation. Circulation 2000;101:2612–2617.
  29. Goette A, Arndt M, Rocken C, et al: Regulation of angiotensin II receptor subtypes during atrial fibrillation in humans. Circulation 2000;101:2678–2681.
  30. Weyerbrock S, Nakai T, Mangat I, et al: Genetic reprogramming and atrial hypertrophy are important for development of atrial fibrillation in canine model (abstract). Pacing Clin Electrophysiol 2001;24:580.
  31. Verheule S, Wilson E, Everett T IV, Shanbhag S, Golden C, Olgin J: Alterations in atrial electrophysiology and tissue structure in canine model of chronic atrial dilatation due to mitral regurgitation. Circ 2003;107:2615–2622.
  32. Bauer A, McDonald AD, Donahue JK: Pathophysiological findings in a model of persistent atrial fibrillation and severe congestive heart failure. Cardiovasc Res 2004;61:764–770.
  33. Sakabe M, Fujiki A, Nishida K, et al: Enalapril prevents perpetuation of atrial fibrillation by suppressing atrial fibrosis and over-expression of connexin 43 in a canine model of atrial pacing-induced left ventricular dysfunction. J Cardiovasc Pharmacol 2004;43:851–859.


Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50