title: Clinical and histological predictive risk factors of atrial fibrillation in patients undergoing open-heart surgery.
abstract: Postoperative atrial fibrillation (POAF) is a common complication subsequent to cardiac surgery. Various risk factors have been reported for the development of this complication; however, their precise role in POAF is unknown. In the present study, we attempted to identify clinical factors and histopathological changes in atrial tissue that may predict the development of POAF. Atrial tissue was sampled from 103 patients in sinus rhythm that had undergone open-heart surgery, including elective coronary artery bypass grafting (79.61%) and heart valve surgery (20.38%). Atrial surgical biopsies were obtained from the right atrial appendage at the site of cannulation, prior to cardiopulmonary bypass. Tissues were processed routinely for light microscopy, then stained with hematoxylin and eosin and sirius red. Microscopical exams were used to observe the atrial lesions and morphometry was conducted for quantification. In total, 37 patients (35.92%) developed POAF and atrial lesions were identified in the majority of patients in the normal postoperative sinus rhythm and POAF groups, but were most common in the POAF patients. The most common risk factors involved in developing POAF were found to be: Age of >60 years, male gender, ejection fraction of <50% and increased pulmonary hypertension. Furthermore, interstitial fibrosis and myocytolysis were the most common injuries identified. Abnormalities in atrial surgical biopsies may indicate the susceptibility of a patient to developing POAF. The present results suggest that the pre-existent alterations in the structure of the right atrium may be a major determinant in the development of POAF.
authors.affiliation: Department of Cardiovascular Surgery, 'Prof. Dr. George I.M. Georgescu' Institute of Cardiovascular Diseases, Iasi 700503, Romania ; Department of Cardiac Surgery, 'Grigore T. Popa' University of Medicine and Pharmacy, Iasi 700115, Romania.
authors.forename: Grigore
authors.initials: G
authors.lastname: Tinica
authors.affiliation: Department of Morpho-Functional Sciences, 'Grigore T. Popa' University of Medicine and Pharmacy, Iasi 700115, Romania.
authors.forename: Veronica
authors.initials: V
authors.lastname: Mocanu
authors.affiliation: Department of Morpho-Functional Sciences, 'Grigore T. Popa' University of Medicine and Pharmacy, Iasi 700115, Romania.
authors.forename: Florin
authors.initials: F
authors.lastname: Zugun-Eloae
authors.affiliation: Department of Cardiovascular Surgery, 'Prof. Dr. George I.M. Georgescu' Institute of Cardiovascular Diseases, Iasi 700503, Romania ; Department of Morpho-Functional Sciences, 'Grigore T. Popa' University of Medicine and Pharmacy, Iasi 700115, Romania.
authors.forename: Doina
authors.initials: D
authors.lastname: Butcovan
keywords: atrial fibrillation; cardiac surgery; cardiopulmonary bypass; interstitial fibrosis; myocytolysis