Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Oct 1999
ReviewTreatment of postoperative atrial fibrillation: a nonsurgical perspective.
Atrial fibrillation is a common complication of cardiovascular surgery. The 2 most important risk factors for its development are advancing age and a preoperative history of atrial fibrillation. ⋯ These strategies are most effective in high-risk patients. When atrial fibrillation does occur, treatment includes control of the ventricular rate, systemic anticoagulation, and conversion back to sinus rhythm.
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Semin. Thorac. Cardiovasc. Surg. · Oct 1999
ReviewA perspective on postoperative atrial fibrillation.
Some patients develop atrial fibrillation after any type of surgery, some patients develop atrial fibrillation only after cardiac surgery, and still other patients never develop postoperative atrial fibrillation. Despite the inherent difficulty in identifying the causes of postoperative atrial fibrillation, several important observations have been made during the recent past that may play a role in treating or even preventing this common and serious postoperative problem. This communication provides a framework within which the problem of postoperative atrial fibrillation can be evaluated and treated.
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Semin. Thorac. Cardiovasc. Surg. · Oct 1999
Potential preoperative markers for the risk of developing atrial fibrillation after cardiac surgery.
Postoperative atrial arrhythmias after cardiac surgical procedures are common, with a reported overall incidence of approximately 50%. The pathophysiological mechanisms responsible for atrial fibrillation after a cardiac procedure remain unclear, although several clinical studies published during the past decade have identified certain preoperative risk factors associated with postoperative atrial fibrillation. In this study, we attempted to identify the histopathological changes in atrial cardiomyocytes that might predict the development of atrial fibrillation during the postoperative period. ⋯ The only clinical independent risk factor for the development of postoperative atrial fibrillation was chronic obstructive pulmonary disease (COPD) (P = .037). Histologically, there were 3 findings in the atrial myocardium that were more common in patients who developed postoperative atrial fibrillation: (1) vacuolation size (P = .017), (2) vacuolation frequency (P = .0136), and (3) lipofuscin content (P = .013). The identification of these histological markers for the development of postoperative atrial fibrillation may contribute not only to our understanding of the underlying pathophysiology that leads to postoperative atrial fibrillation but also to a method of preventing this troublesome complication of cardiac surgery.