title: Association between renin-angiotensin-aldosterone system blockers and postoperative atrial fibrillation in patients with mild and moderate left ventricular dysfunction.
abstract: OBJECTIVE
  The aim of the study was to evaluate the association between renin - angiotensin - aldosterone system blockers and risk of postoperative atrial fibrillation (AF) development in patients with mild and moderate left ventricular systolic dysfunction.
  
  
  METHODS
  The population of this prospective and observational study consisted of 269 patients with an ejection fraction of < or = 50% undergoing coronary artery bypass and/or valve surgery. Use of renin -angiotensin-aldosterone system blockers (angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB) and spironolactone) and their association with postoperative AF (AF episode lasting < or = 5 min) were evaluated. In statistical analysis t test for independent samples, Chi-square test and Mann Whitney U test were used for comparison of variables between groups. Predictors of postoperative AF were determined by multiple logistic regression analysis.
  
  
  RESULTS
  During follow-up, 50 patients (13%) developed postoperative AF. With multiple logistic regression analysis, risk factors for postoperative AF were determined: left atrial diameter (OR- 1.09; 95%CI 1.01-1.16, p=0.02), age (OR-1.04; 95%CI 1.002- 1.08, p=0.04), aortic cross-clamp duration (OR- 1.03, 95%CI -1.00-1.05, p=0.01), use of left internal mammarian artery (OR-0.33; 95%CI 0.13-0.88, p=0.03), ACEIs treatment (OR-0.27; 95%CI 0.12-0.62, p=0.002), and ARBs treatment (OR - 0.21, 95%CI 0.07-0.62, p=0.005).
  
  
  CONCLUSIONS
  Our results indicate that although treatments with ACEIs and ARBs are associated with low incidence of postoperative AF in patients with mild and moderate left ventricular systolic dysfunction, treatment with spironolactone is not.
authors.affiliation: Department of Cardiology, Süleyman Demirel University, Isparta, Turkey. drmehmetozaydin@yahoo.com
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ozaydin
authors.forename: Ercan
authors.initials: E
authors.lastname: Varol
authors.forename: Yasin
authors.initials: Y
authors.lastname: Türker
authors.forename: Oktay
authors.initials: O
authors.lastname: Peker
authors.forename: Doğan
authors.initials: D
authors.lastname: Erdoğan
authors.forename: Abdullah
authors.initials: A
authors.lastname: Doğan
authors.forename: Erdoğan
authors.initials: E
authors.lastname: Ibrişim
mesh_terms: D018674:Adrenergic Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D011183:Postoperative Complications / Q000453:epidemiology; D011237:Predictive Value of Tests; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012307:Risk Factors; D013148:Spironolactone / Q000627:therapeutic use; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000601:surgery*
chemical_list: D018674:Adrenergic Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone