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Role of Preexisting Proarrhythmic Atrial Remodeling in Post-Coronary Artery Bypass Grafting Atrial Fibrillation

Alkora Ioana Balan
Alkora Ioana Balan
, 
Irina Pintilie
Irina Pintilie
, 
Cristina Somkereki
Cristina Somkereki
, 
Marcel Perian
Marcel Perian
, 
Laura Chinezu
Laura Chinezu
, 
Claudia Banescu
Claudia Banescu
, 
Razvan Constantin Serban
Razvan Constantin Serban
 und 
Alina Scridon
Alina Scridon
   | 05. Mai 2022
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Article Category: Original Article
Online veröffentlicht: 05. Mai 2022
Seitenbereich: 597 - 607
DOI: https://doi.org/10.47803/rjc.2021.31.3.597
Schlüsselwörter
© 2021 Alkora Ioana Balan et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

Flow chart of the study designAF – atrial fibrillation; APD25 – action potential duration to 25% of complete repolarization; APD50 – action potential duration to 50% of complete repolarization; APD90 – action potential duration to 90% of complete repolarization; CABG – coronary artery bypass grafting; CACNA1C – calcium voltage-gated channel subunit alpha 1c; GAPDH – glyceraldehyde 3-phosphate dehydrogenase; GJA5 – gap junction protein alpha 5; HF – high-frequency components; HR – heart rate; KCNE2 – potassium voltage-gated channel subfamily E member 2; KCNJ2 – potassium inwardly rectifying channel subfamily J member 2; KCNQ1 – potassium voltage-gated channel subfamily Q member 1; LF – low-frequency components; LF/HF – ratio between low-frequency and high-frequency components; mRNA – messenger ribonucleic acid; pNN50 – proportion of successive RR intervals that differed by >50 ms; RMSSD – root mean square of successive differences between normal heartbeats; SCN5A – sodium voltage-gated channel alpha subunit 5; SDNN – standard deviation of normal RR intervals
Flow chart of the study designAF – atrial fibrillation; APD25 – action potential duration to 25% of complete repolarization; APD50 – action potential duration to 50% of complete repolarization; APD90 – action potential duration to 90% of complete repolarization; CABG – coronary artery bypass grafting; CACNA1C – calcium voltage-gated channel subunit alpha 1c; GAPDH – glyceraldehyde 3-phosphate dehydrogenase; GJA5 – gap junction protein alpha 5; HF – high-frequency components; HR – heart rate; KCNE2 – potassium voltage-gated channel subfamily E member 2; KCNJ2 – potassium inwardly rectifying channel subfamily J member 2; KCNQ1 – potassium voltage-gated channel subfamily Q member 1; LF – low-frequency components; LF/HF – ratio between low-frequency and high-frequency components; mRNA – messenger ribonucleic acid; pNN50 – proportion of successive RR intervals that differed by >50 ms; RMSSD – root mean square of successive differences between normal heartbeats; SCN5A – sodium voltage-gated channel alpha subunit 5; SDNN – standard deviation of normal RR intervals

Figure 2

Typical histological findings in (A) patients who developed and (B) patients who did not develop post-coronary artery bypass grafting atrial fibrillation. Masson's trichrome staining. Compared to patients without atrial fibrillation (B), increased subepicardial adipose tissue can be noticed in patients with postoperative atrial fibrillation (A).
Typical histological findings in (A) patients who developed and (B) patients who did not develop post-coronary artery bypass grafting atrial fibrillation. Masson's trichrome staining. Compared to patients without atrial fibrillation (B), increased subepicardial adipose tissue can be noticed in patients with postoperative atrial fibrillation (A).

Clinical and surgical characteristics and ongoing drug treatment in patients who developed versus patients who did not develop post-coronary artery bypass grafting atrial fibrillation

AF (n = 11) No-AF (n = 19) p value
Baseline clinical characteristics
Age (years) 66 (60–72) 58 (55–64) 0.04
Male gender (n, %) 9 (78.94) 15 (81.81) >0.99
Body mass index (kg/m2) 26.08 (23.94–30.84) 27.34 (24.38–31.05) 0.58
Left ventricular ejection fraction (%) 50 (45–60) 50 (45–55) 0.74
SYNTAX I score (points) 32.0 (23.5–35.0) 22.0 (17.0–28.0) 0.08
Creatinine clearance (ml/min/1.73 m2) 89.98 (63.76–120.60) 92.42 (72.89–111.90) 0.80
Medical history
Obesity (n, %) 3 (27.27) 5 (25.31) >0.99
Hypertension (n, %) 11 (100.00) 18 (94.73) >0.99
Diabetes mellitus (n, %) 6 (54.54) 5 (26.31) 0.23
Stroke (n, %) 3 (27.27) 3 (15.7%) 0.64
CHA2DS2VASc score (points) 3 (3–5) 2 (2–4) 0.04
Ongoing drug treatment
Angiotensin converting enzyme inhibitor (n, %) 10 (90.90) 14 (73.68) >0.99
Antialdosteronic (n, %) 0 (0.00) 2 (10.52) >0.99
Statin (n, %) 9 (81.81) 18 (94.73) >0.99
Beta-blocker (n, %) 9 (81.81) 18 (94.73) 0.26
Surgical parameters
Total duration of the intervention (min) 247 (225–318) 222 (200–276) 0.26
ECC duration (min) 113 (95–138) 89 (64–129) 0.23
Aortic clamping time (min) 71 (49–79) 45 (37–74) 0.20

Multi-approach assessment of preexisting atrial electrical remodeling in patients who developed versus patients who did not develop post-coronary artery bypass grafting atrial fibrillation

AF (n = 11) No-AF (n = 19) p value
Surface ECG parameters
P-wave duration (ms)
Lead II 80 (80–120) 100 (80–100) 0.32
Lewis lead 80 (60–80) 80 (80–100) 0.22
P-wave amplitude (mV)
Lead II 0.10 (0.05–0.10) 0.10 (0.10–0.15) 0.15
Lewis lead 0.05 (0.05–0.10) 0.05 (0.05–0.10) 0.89
P-wave fragmentation (n, %)
Lead II 3 (27.27) 8 (42.10) 0.61
Lewis lead 6 (54.54) 9 (47.36) 0.68
12-lead Holter ECG parameters
Atrial premature beats / 24-h 858 (0–109) 7 (4–21) 0.26
mRNA levels (normalized with GAPDH)
CACNA1C 28.24 (26.32–29.27) 28.01 (25.82–29.29) 0.52
GJA5 26.18 (25.25–28.84) 25.84 (24.41–28.14) 0.43
KCNE2 31.86 (31.16–32.50) 31.72 (30.67–32.71) 0.79
KCNJ2 30.58 (29.75–32.28) 30.47 (28.9–32.35) 0.76
KCNQ1 28.92 (27.92–30.38) 29.07 (27.02–29.71) 0.76
SCN5A 27.81 (27.08–30.32) 27.92 (25.55–29.14) 0.39

Heart rate variability parameters in patients who developed versus patients who did not develop post-coronary artery bypass grafting atrial fibrillation

AF (n = 11) No-AF (n = 19) p value
Mean HR (bpm) 71.50 (66.00–82.25) 64.00 (61.50–69.50) 0.03
Time domain parameters
SDNN (ms) 118.00 (95.25–172.80) 101.00 (86.00–140.00) 0.60
RMSSD (ms) 89.00 (45.75–172.00) 53.00 (41.50–67.50) 0.03
pNN50 (%) 9.87 (2.75–20.00) 6.00 (3.00–10.50) 0.39
Frequency domain parameters
LF (ms2) 11.70 (2.49–19.35) 18.85 (10.90–26.93) 0.13
HF (ms2) 51.80 (40.90–64.20) 62.30 (48.03–71.98) 0.21
LF/HF 0.22 (0.10–0.56) 0.30 (0.21–0.44) 0.31

Parameters of atrial structural remodeling in patients who developed versus patients who did not develop post-coronary artery bypass grafting atrial fibrillation

AF (n = 11) No-AF (n = 19) p value
Echocardiographic parameters
LA antero-posterior diameter (mm) 37 (35–40) 38 (34–40) 0.63
LA area (cm2) 19.25 (16.88–20.52) 18.90 (17.30–19.00) 0.38
Histological parameters (semiquantitative analysis)
Inflammatory infiltrate (score) 1.00 (0.00–2.00) 1.00 (1.00–1.37) 0.70
Subepicardial adipose tissue (score) 2.00 (1.00–3.00) 1.00 (1.00–1.50) 0.02
Interstitial adipose tissue (score) 0.00 (0.00–1.12) 0.50 (0.00–1.00) 0.89
Perivascular fibrosis (score) 1.00 (1.00–1.00) 1.00 (1.00–1.00) 0.71
Interstitial fibrosis (score) 1.00 (0.00–1.00) 1.00 (0.25–1.00) 0.89
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