Atrial fibrillation after cardiac surgery/cardiopulmonary bypass is associated with monocyte activation.
Atrial fibrillation (AF) contributes significantly to morbidity and mortality in as many as one-third of patients after cardiac surgery that requires cardiopulmonary bypass (CPB). Recent data suggest that inflammatory infiltration of the myocardium may predispose to AF. We conducted an exploratory pilot study to determine if there was an association between the perioperative leukocyte inflammatory response to cardiac surgery/CPB and postoperative AF. We enrolled 72 patients undergoing cardiac surgery with CPB; all patients were in sinus rhythm before surgery. Leukocyte activation (CD11b upregulation) was perioperatively measured in monocytes and neutrophils (PMN). Preoperative C-reactive protein (CRP) and perioperative neutrophil myeloperoxidase (MPO) were also monitored for inflammation, and troponin I was assayed for perioperative cardiac muscle damage. All markers were evaluated for differences between the subset of patients who developed AF versus those who remained in normal sinus rhythm after surgery. All 72 patients completed the study. Postoperative AF developed in 26 (36%) patients. Perioperative monocyte CD11b upregulation was significantly increased in patients who developed AF (P = 0.01), but increases in PMN CD11b were not significantly associated with AF (P = 0.057). The increase in both monocyte and PMN counts after aortic cross-clamp release was significantly associated with postoperative AF (P = 0.007 and P = 0.005, respectively). By contrast, preoperative CRP and perioperative MPO did not differ between AF and normal rhythm patients. Similarly, the peak value of troponin I did not differ between groups. In this pilot study of cardiac surgery/CPB patients, perioperative upregulation of the monocyte adhesion receptor, CD11b, and higher circulating monocyte and PMN numbers were associated with postoperative AF, suggesting that the induction of cellular inflammation during cardiac surgery/CPB may contribute to this pathophysiology.
Department of Anesthesiology, Yale School of Medicine, PO Box 208051, 333 Cedar St., New Haven, CT 06520-8051, USA.
Manuel L
ML
Fontes
Joseph P
JP
Mathew
Henry M
HM
Rinder
Daniel
D
Zelterman
Brian R
BR
Smith
Christine S
CS
Rinder
D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood* / Q000209:etiology*; D015415:Biomarkers; D002097:C-Reactive Protein / Q000378:metabolism; D039481:CD11b Antigen / Q000097:blood; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D003250:Constriction; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D007432:Intraoperative Period; D008262:Macrophage Activation / Q000502:physiology*; D008297:Male; D016343:Monitoring, Intraoperative; D009000:Monocytes / Q000378:metabolism / Q000502:physiology*; D009504:Neutrophils / Q000502:physiology; D010865:Pilot Projects; D011183:Postoperative Complications / Q000097:blood*; D012372:ROC Curve
D015415:Biomarkers; D039481:CD11b Antigen; D002097:C-Reactive Protein