title: Inflammation in new-onset atrial fibrillation after cardiac surgery: a systematic review.
abstract: BACKGROUND
  Postoperative new-onset atrial fibrillation (PNAF) is the most common complication following cardiac surgery. The pathogenesis of PNAF is multifactorial. The concept of the postoperative inflammatory response, as a potential underlying mechanism has been extensively studied. This review aims to provide a comprehensive summary of literature relevant to the association between the inflammatory response following cardiac surgery and PNAF.
  
  
  METHODS
  MEDLINE, EMBASE and the Cochrane Central Register were systematically reviewed by two independent investigators for studies published between January 1980 and May 2012, in which an association between serum markers of inflammation and PNAF was evaluated, or the effect of drugs with anti-inflammatory properties on the risk of PNAF.
  
  
  RESULTS
  Sixty-three studies met selection criteria (39 observational and 24 randomized studies) including 27,363 patients. The mean incidence of PNAF after cardiac surgery was 25·5%. Elevated levels of various inflammatory mediators were associated with PNAF, and the most consistent association was found between white blood cell count and PNAF. Of the drugs with anti-inflammatory properties, statins gave the best protective effect against PNAF, followed by anti-oxidants, steroids and colchicine. Nonsteroidal anti-inflammatory drugs did not prevent PNAF significantly.
  
  
  CONCLUSIONS
  The postoperative inflammation response may play a role in the pathogenesis of PNAF. However, of the inflammation biomarkers, only elevated white blood cell count reliably predicts PNAF. Pre- and perioperative use of statins and several other drugs with anti-inflammatory properties reduce the incidence of PNAF.
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Anesthesiology and Intensive Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Kirolos A
authors.initials: KA
authors.lastname: Jacob
authors.forename: Hendrik M
authors.initials: HM
authors.lastname: Nathoe
authors.forename: Jan M
authors.initials: JM
authors.lastname: Dieleman
authors.forename: Dirk
authors.initials: D
authors.lastname: van Osch
authors.forename: Jolanda
authors.initials: J
authors.lastname: Kluin
authors.forename: Diederik
authors.initials: D
authors.lastname: van Dijk
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000975:Antioxidants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000209:etiology*; D015415:Biomarkers / Q000378:metabolism; D006348:Cardiac Surgical Procedures; D003078:Colchicine / Q000627:therapeutic use; D004812:Epidemiologic Methods; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007249:Inflammation / Q000503:physiopathology; D011183:Postoperative Complications / Q000209:etiology*; D013256:Steroids / Q000627:therapeutic use; D014815:Vitamins / Q000627:therapeutic use
chemical_list: D000893:Anti-Inflammatory Agents; D000975:Antioxidants; D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D013256:Steroids; D014815:Vitamins; D003078:Colchicine; D000111:Acetylcysteine
keywords: Anti-inflammatory drugs; cardiac surgery; inflammation; inflammatory biomarkers; postoperative new-onset atrial fibrillation