Brain natriuretic peptide concentration in pericardial fluid is independently associated with atrial fibrillation after off-pump coronary artery bypass surgery.
OBJECTIVE
Postoperative atrial fibrillation is associated with the increased incidence of morbidities and mortality. Predisposing determinants of atrial fibrillation development after off-pump coronary artery bypass grafting remain unclear. We hypothesized that pericardial fluid natriuretic peptide concentrations have a predictive value for developing postoperative atrial fibrillation in patients who have undergone off-pump coronary artery bypass grafting.


METHODS
We prospectively measured atrial natriuretic peptide and brain natriuretic peptide concentrations in plasma and pericardial fluid in 42 consecutive patients undergoing off-pump coronary artery bypass grafting, then continuously observed the occurrence of atrial fibrillation following off-pump coronary artery bypass grafting until the time of discharge.


RESULTS
Postoperative atrial fibrillation was documented in nine patients (21%, atrial fibrillation group), and not in 33 patients (no atrial fibrillation group). Between the groups, there was neither significant difference in plasma atrial natriuretic peptide concentrations nor in pericardial atrial natriuretic peptide concentrations. Plasma brain natriuretic peptide concentrations were comparable in both groups [56.2 (interquartile range 42.7-102.8) vs. 35.2 pg/ml (13.8-75.0), P=0.07]. Pericardial fluid brain natriuretic peptide concentrations were significantly higher in the atrial fibrillation group than in the no atrial fibrillation group [188.0 (124.8-411.0) vs. 39.3 pg/ml (10.0-88.4), P=0.0001]. In a multivariable logistic regression model, pericardial brain natriuretic peptide concentration was significantly associated with a higher risk of postoperative atrial fibrillation (odds ratio=3.0 every 50 pg/ml increase; 95% confidence interval, 1.1-8.6; P=0.04).


CONCLUSIONS
Our results suggested that pericardial fluid brain natriuretic peptide concentration is independently associated with the development of atrial fibrillation after off-pump coronary artery bypass grafting.
Nakamura
Takeshi
T
Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan. tnak@koto.kpu-m.ac.jp
Azuma
Akihiro
A
Sawada
Takahisa
T
Sakamoto
Kenzo
K
Yamano
Tetsuhiro
T
Yaku
Hitoshi
H
Matsubara
Hiroaki
H
D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis*; D009320:Atrial Natriuretic Factor / Q000032:analysis / Q000097:blood; D047549:Coronary Artery Bypass, Off-Pump; D045604:Extracellular Fluid / Q000737:chemistry; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000032:analysis* / Q000097:blood; D010496:Pericardium / Q000737:chemistry*; D011183:Postoperative Complications / Q000175:diagnosis*; D011379:Prognosis
D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor