Document Detail


Recent developments in pharmacologic prophylaxis of atrial fibrillation in patients undergoing surgical revascularization.
MedLine Citation:
PMID:  19355875     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Atrial fibrillation is a frequent complication after CABG. It occurs in 20-50% of patients, most often between the 2nd and 3rd postoperative day. About 40 % of patients experience more than 1 episode. Postoperative AF (POAF) is associated with an increase in adverse events and hospital stay and, therefore, costs of care. The incidence of POAF is not influenced by the technique of CABG with or without cardiopulmonary by-pass Neurohormonal activation, electrolyte imbalance, fluid overload, surgical practices and finally an exaggerated inflammatory response has been proposed to be etiological factor. Advanced age, history of AF or heart failure, COPD, postoperative withdrawal of beta-blockers are independent risk factors of postoperative AF. Conversely, postoperative administration of beta-blockers, ACE inhibitors, potassium supplementation and NSAID were associated with a reduced risk of POAF. Pharmacological strategies for prevention of POAF may be divided in two main groups : the first one encompasses the use of antiarrhythmic drugs (amiodarone, metoprolol, sotalol) before and /or after surgery and has been extensively investigated in the last two decades. Recently an Italian study has shown that PUFA administration during hospitalization in patients undergoing CABG significantly decreased the incidence of POAF and was associated with a shorter hospital stay. Since an exaggerated inflammatory reaction may play a significant role in POAF, treatments directed to antagonize inflammation are presently under investigation. Despite different action mechanisms both hydrocortisone and statins have been shown to decrease post-operative AF risk. These two prophylactic regimens are not mutually exclusive and some data suggest that their association may be useful to further decrease the risk of POAF.
Authors:
Carlo Rostagno
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Cardiovascular & hematological agents in medicinal chemistry     Volume:  7     ISSN:  1875-6182     ISO Abbreviation:  -     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-04-09     Completed Date:  2009-07-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101266881     Medline TA:  Cardiovasc Hematol Agents Med Chem     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  137-46     Citation Subset:  IM    
Affiliation:
Cardiologia Generale 1, AOU Careggi, Firenze, Italia. c.rostagno@katamail.com
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MeSH Terms
Descriptor/Qualifier:
Animals
Atrial Fibrillation / economics,  epidemiology,  physiopathology,  prevention & control*
Chemoprevention
Coronary Artery Bypass* / economics,  methods,  statistics & numerical data
Guidelines as Topic
Humans
Risk Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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