Inflammation in new‐onset atrial fibrillation after cardiac surgery: a systematic review. (30th January 2014)

• Record Type: Journal Article
• Authors: Jacob, Kirolos A.; Nathoe, Hendrik M.; Dieleman, Jan M.; van, Dirk; Kluin, Jolanda; van, Diederik
• Is Part Of: European journal of clinical investigation. Volume 44:Number 4(2014:Apr.)
• Page Start: 402
• Page End: 428
• Publication Date: 2014-01-30
• Subjects: Pathology -- Periodicals; Medical research -- Periodicals; 616.075
• DOI: 10.1111/eci.12237
• Languages: English
• ISSNs: 0014-2972

Abstract

<abstract abstract-type="main" id="eci12237-abs-0001"> <title>Abstract</title> <sec id="eci12237-sec-0001" sec-type="section"> <title>Background</title> <p>Postoperative new‐onset atrial fibrillation (PNAF) is the most common complication following cardiac surgery. The pathogenesis of PNAF is multifactorial. The concept of the postoperative inflammatory response, as a potential underlying mechanism has been extensively studied. This review aims to provide a comprehensive summary of literature relevant to the association between the inflammatory response following cardiac surgery and PNAF.</p> </sec> <sec id="eci12237-sec-0002" sec-type="section"> <title>Design</title> <p>MEDLINE, EMBASE and the Cochrane Central Register were systematically reviewed by two independent investigators for studies published between January 1980 and May 2012, in which an association between serum markers of inflammation and PNAF was evaluated, or the effect of drugs with anti‐inflammatory properties on the risk of PNAF.</p> </sec> <sec id="eci12237-sec-0003" sec-type="section"> <title>Results</title> <p>Sixty‐three studies met selection criteria (39 observational and 24 randomized studies) including 27 363 patients. The mean incidence of PNAF after cardiac surgery was 25·5%. Elevated levels of various inflammatory mediators were associated with PNAF, and the most consistent association was found between white blood cell count and PNAF. Of the drugs with anti‐inflammatory properties, statins gave the best protective effect against PNAF, followed by anti‐oxidants, steroids and colchicine. Nonsteroidal anti‐inflammatory drugs did not prevent PNAF significantly.</p> </sec> <sec id="eci12237-sec-0004" sec-type="section"> <title>Conclusion</title> <p>The postoperative inflammation response may play a role in the pathogenesis of PNAF. However, of the inflammation biomarkers, only elevated white blood cell count reliably predicts PNAF. Pre‐ and perioperative use of statins and several other drugs with anti‐inflammatory properties reduce the incidence of PNAF.</p> </sec> </abstract>