• Jason H Y Wu, Roberto Marchioli, Maria G Silletta, Serge Masson, Frank W Sellke, Peter Libby, Ginger L Milne, Nancy J Brown, Federico Lombardi, Ralph J Damiano, Joann Marsala, Mauro Rinaldi, Alberto Domenech, Caterina Simon, Luigi Tavazzi, and Dariush Mozaffarian.
• George Institute for Global Health, Sydney Medical School, The University of Sydney, New South Wales, Australia (J.Y.W.).
• J Am Heart Assoc. 2015 May 20; 4 (5).

BackgroundAnimal study results point to oxidative stress as a key mechanism triggering postoperative atrial fibrillation (PoAF), yet the extent to which specific biomarkers of oxidative stress might relate to PoAF risk in humans remains speculative.Methods And ResultsWe assessed the association of validated, fatty acid-derived oxidative stress biomarkers (F2-isoprostanes, isofurans, and F3-isoprostanes) in plasma and urine, with incident PoAF among 551 cardiac surgery patients. Biomarkers were measured at enrollment, the end of surgery, and postoperative day 2. PoAF lasting ≥30 seconds was confirmed with rhythm strip or electrocardiography and centrally adjudicated. Outcomes were assessed until hospital discharge or postoperative day 10, whichever occurred first. Urine level of each oxidative stress biomarker rose at the end of surgery (2- to 3-fold over baseline, P<0.001) and subsequently declined to concentrations comparable to baseline by postoperative day 2. In contrast, plasma concentrations remained relatively stable throughout the perioperative course. Urine F2-isoprostanes and isofurans at the end of surgery were 20% and 50% higher in subjects who developed PoAF (P≤0.009). While baseline biomarker levels did not associate significantly with PoAF, end of surgery and postoperative day 2 isoprostanes and isofurans demonstrated relatively linear associations with PoAF. For example, the end of surgery extreme quartile multivariate adjusted OR (95% CI) for urine isofurans and F3-isoprostanes were 1.95 (1.05 to 3.62; P for trend=0.01) and 2.10 (1.04 to 2.25, P for trend=0.04), respectively. The associations of biomarkers with PoAF varied little by demographics, surgery type, and medication use (P≥0.29 for each).ConclusionsThese novel results add to accumulating evidence supporting the likely key pathogenic role of elevated oxidative stress in PoAF.Clinical Trial RegistrationURL: Clinicaltrials.gov Unique identifier: NCT00970489.© 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

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