Postoperative inflammatory reaction and atrial fibrillation: simple correlation or causation?
Atrial fibrillation after cardiac operations is a source of morbidity and resource consumption. This systematic review of literature analyzes the current evidence on its pathophysiologic link with the systemic inflammatory response elicited by surgery and cardiopulmonary bypass. Meta-analysis of randomized studies on the effect of off-pump surgery or statin pre-treatment on the incidence of atrial fibrillation was performed. The concept of inflammation as a pathophysiologic determinant of postoperative atrial fibrillation is supported by the literature. The modulation of post-cardiopulmonary bypass systemic inflammation will probably represent a major therapeutic goal in the prevention of postoperative atrial fibrillation. Statins seem to be the most promising pharmacological strategy.
Anselmi
Amedeo
A
Division of Cardiac Surgery, Catholic University, Rome, Italy. amedeo.anselmi@alice.it
Possati
Gianfederico
G
Gaudino
Mario
M
D001281:Atrial Fibrillation / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D002097:C-Reactive Protein / Q000378:metabolism*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects* / Q000379:methods; D003327:Coronary Disease / Q000175:diagnosis / Q000401:mortality; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D018836:Inflammation Mediators / Q000032:analysis; D008297:Male; D018384:Oxidative Stress / Q000502:physiology*; D011183:Postoperative Complications / Q000517:prevention & control; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D018836:Inflammation Mediators; D002097:C-Reactive Protein