title: Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery.
abstract: Postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery that occurs in up to 60% of patients. POAF is associated with increased risk of cardiovascular mortality, stroke and other arrhythmias that can impact on early and long term clinical outcomes and health economics. Many factors such as disease-induced cardiac remodelling, operative trauma, changes in atrial pressure and chemical stimulation and reflex sympathetic/parasympathetic activation have been implicated in the development of POAF. There is mounting evidence to support a major role for inflammation and oxidative stress in the pathogenesis of POAF. Both are consequences of using cardiopulmonary bypass and reperfusion following ischaemic cardioplegic arrest. Subsequently, several anti-inflammatory and antioxidant drugs have been tested in an attempt to reduce the incidence of POAF. However, prevention remains suboptimal and thus far none of the tested drugs has provided sufficient efficacy to be widely introduced in clinical practice. A better understanding of the cellular and molecular mechanisms responsible for the onset and persistence of POAF is needed to develop more effective prediction and interventions.
authors.affiliation: Bristol Heart Institute, University of Bristol, Level 7, Bristol Royal Infirmary, Upper Maudlin Street, Bristol BS2 8HW, UK.
authors.forename: M
authors.initials: M
authors.lastname: Zakkar
authors.affiliation: Bristol Heart Institute, University of Bristol, Level 7, Bristol Royal Infirmary, Upper Maudlin Street, Bristol BS2 8HW, UK.
authors.forename: R
authors.initials: R
authors.lastname: Ascione
authors.affiliation: School of Physiology & Pharmacology, University of Bristol, Medical Sciences Building, University Walk, Bristol, BS8 1TD, UK.
authors.forename: A F
authors.initials: AF
authors.lastname: James
authors.affiliation: Bristol Heart Institute, University of Bristol, Level 7, Bristol Royal Infirmary, Upper Maudlin Street, Bristol BS2 8HW, UK.
authors.forename: G D
authors.initials: GD
authors.lastname: Angelini
authors.affiliation: Bristol Heart Institute, University of Bristol, Level 7, Bristol Royal Infirmary, Upper Maudlin Street, Bristol BS2 8HW, UK. Electronic address: m.s.suleiman@bristol.ac.uk.
authors.forename: M S
authors.initials: MS
authors.lastname: Suleiman
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D001205:Ascorbic Acid / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000517:prevention & control; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003078:Colchicine / Q000008:administration & dosage; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage; D007249:Inflammation / Q000378:metabolism*; D018836:Inflammation Mediators / Q000378:metabolism; D015428:Myocardial Reperfusion Injury / Q000503:physiopathology; D018384:Oxidative Stress / Q000502:physiology*; D011183:Postoperative Complications / Q000503:physiopathology* / Q000517:prevention & control; D017382:Reactive Oxygen Species; D012307:Risk Factors; D018746:Systemic Inflammatory Response Syndrome / Q000503:physiopathology; D014810:Vitamin E / Q000008:administration & dosage
chemical_list: D000305:Adrenal Cortex Hormones; D015525:Fatty Acids, Omega-3; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D018836:Inflammation Mediators; D017382:Reactive Oxygen Species; D014810:Vitamin E; D001205:Ascorbic Acid; D003078:Colchicine
keywords: Cardiac surgery; Cardiopulmonary bypass; Inflammation; Ischaemia; Oxidative stress; Postoperative atrial fibrillation