A Retrospective Study of Coronary Artery Bypass Grafting with Low-Thermal Plasma Dissection Device Compared to Conventional Monopolar Electrosurgery.

INTRODUCTION: The objective of this study is to compare the effects of conventional monopolar electrosurgery (CMES) and low-thermal plasma kinetic cautery (PKC) on complications such as bleeding, abnormal wound healing, pain, and drainage in patients who underwent on-pump coronary artery bypass grafting (CABG). METHODS: This retrospective clinical study included 258 patients undergoing CABG; the patients were randomized to PKC (PEAK PlasmaBlade, n=153) and CMES (n=105) groups. The patients' clinical data were examined retrospectively for biochemical variables, postoperative drainage, post-surgery erythrocyte suspension transfusion count, surgical site pain examined with visual analogue scale (VAS), and wound healing. Two-sided P-value > 0.05 was considered as statistically significant. RESULTS: The median post-surgery erythrocyte suspension transfusion number was significantly lower with PKC compared to CMES (0 [0-1] vs. 1 [1-4], respectively, P<0.001). Mean postoperative drain output and time until removal of drain tubes were significantly lower with PKC compared to CMES (300±113 vs. 547±192 and 1.95±1.5 vs. 2.44±1.8; P<0.001 and P=0.025, respectively). Mean VAS score for spontaneous and cough-induced pain were significantly lower with PKC compared to CMES (1.98±1.51 vs. 3.94± 2.09 and 3.76±1.46 vs. 5.6±1.92; P<0.001 for both comparisons). Reoperation due to bleeding was significantly higher with CMES compared to PKC (0 vs. 11 [7.2%], P=0.001). CONCLUSION: Use of PKC during CABG considerably reduces postoperative drainage, need for blood transfusion, reoperation due to bleeding, and postoperative pain. PCK appears to be a good alternative to CMES for CABG.

The Validation of the ATRIA and CHA2DS2-Vasc Scores in Predicting Atrial Fibrillation after Coronary Artery Bypass Surgery.

OBJECTIVE: The aim of this study was to evaluate the value of CHA2DS2-VASc and Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) risk scores for prediction of postoperative atrial fibrillation (AF) development in patients undergoing coronary artery bypass grafting (CABG) operation. METHODS: The population of this observational study consisted of 370 patients undergoing CABG operation. CHA2DS2-VASc and ATRIA risk scores were calculated for all patients and their association with postoperative AF (AF episode lasting > 5 min) were evaluated. Predictors of postoperative AF were determined by multiple logistic regression analysis. RESULTS: During follow-up, 110 patients (29.7%) developed postoperative AF. With multiple logistic regression analysis, risk factors for postoperative AF were determined: ATRIA risk score (odds ratio [OR] 1.23; 95% confidence interval [CI] 1.11-1.36; P<0.001), fasting glucose level (OR 1.006; 95% CI 1.004-1.009; P<0.001), and 24-hour drainage amount (OR 1.002; 95% CI; 1.001-1.004; P<0.001). Receiver operating characteristic curve analyses showed that CHA2DS2-VASc and ATRIA risk scores were significant predictors for new-onset AF (C-statistic 0.648; 95% CI 0.59-0.69; P<0.001; and C-statistic 0.664; 95% CI 0.61-0.71; P<0.001, respectively). CONCLUSION: CHA2DS2-VASc and ATRIA risk scores predict new AF in patients undergoing CABG.

Predictive values of C-reactive protein/albumin ratio in new-onset atrial fibrillation after coronary artery bypass grafting.

OBJECTIVE: This study aimed to investigate the predictive value of the newly defined C-Reactive Protein (CRP)/Albumin Ratio (CAR) in determining the development of atrial fibrillation (AF) in comparison with other inflammatory markers, such as Neutrophil/Lymphocyte (N/L) Ratio and Platelet/Lymphocyte (P/L) Ratio, in patients undergoing Coronary Artery Bypass Grafting (CABG) surgery. METHODS: The population of this observational study consisted of 415 patients undergoing CABG. The study cohort was subdivided into two groups based on the development of AF. Complete blood counts, serum CRP, and serum albumin levels were evaluated before the CABG. The CAR, N/L, and P/L ratios of all the patients were calculated. Predictors of postoperative AF were determined by multiple logistic regression analysis (MLRA). RESULTS: During follow-up, 136 patients (32.8%) developed postoperative AF. With MLRA, independent risk factors for postoperative AF were determined as follows: fasting glucose level (OR: 1.01; 95 % CI: 1.00-1.01, P <0.001), age (OR: 1.12; 95 % CI: 1.07-1.17, P <0.001), left ventricle ejection fraction (OR: 0.90; 95 % CI: 0.87-0.94, P <0.001), male gender (OR: 3.32; 95 % CI: 1.39-7.90, P = 0.007), 24-hour drainage amount (OR: 1.004; 95 % CI: 1.002-1.005, P <0.001), and CAR (OR: 1.82; 95 % CI: 1.53-2.16, P <0.001). Receiver Operating Characteristic curve analysis showed that CAR (C-statistic: 0.75; 95% CI: 0.71-0.79, p< 0.001) was a significant predictor of AF. CONCLUSION: Novel inflammatory marker CAR can be used as a reliable marker to predict the development of AF following CABG.

Relationship between c-reactive protein/albumin ratio and new-onset atrial fibrillation after coronary artery bypass grafting.

OBJECTIVE: This study aimed to investigate the predictive value of the newly defined C-Reactive Protein (CRP)/Albumin Ratio (CAR) in determining the development of atrial fibrillation (AF) in comparison with other inflammatory markers, such as Neutrophil/Lymphocyte (N/L) Ratio and Platelet/Lymphocyte (P/L) Ratio, in patients undergoing Coronary Artery Bypass Grafting (CABG) surgery. METHODS: The population of this observational study consisted of 415 patients undergoing CABG. The study cohort was subdivided into two groups based on the development of AF. Complete blood counts, serum CRP, and serum albumin levels were evaluated before the CABG. The CAR, N/L, and P/L ratios of all the patients were calculated. Predictors of postoperative AF were determined by multiple logistic regression analysis (MLRA). RESULTS: During follow-up, 136 patients (32.8%) developed postoperative AF. With MLRA, independent risk factors for postoperative AF were determined as follows: fasting glucose level (OR: 1.01; 95 % CI: 1.00-1.01, P <0.001), age (OR: 1.12; 95 % CI: 1.07-1.17, P <0.001), left ventricle ejection fraction (OR: 0.90; 95 % CI: 0.87-0.94, P <0.001), male gender (OR: 3.32; 95 % CI: 1.39-7.90, P = 0.007), 24-hour drainage amount (OR: 1.004; 95 % CI: 1.002-1.005, P <0.001), and CAR (OR: 1.82; 95 % CI: 1.53-2.16, P <0.001). Receiver Operating Characteristic curve analysis showed that CAR (C-statistic: 0.75; 95% CI: 0.71-0.79, p< 0.001) was a significant predictor of AF. CONCLUSION: Novel inflammatory marker CAR can be used as a reliable marker to predict the development of AF following CABG.

Frontal plane QRS-T angle may be a predictor for post-coronary artery bypass graft surgery atrial fibrillation.

BACKGROUND: New-onset postoperative atrial fibrillation (POAF) is the most common arrhythmia following coronary artery bypass graft surgery (CABG) and is associated with prolonged hospitalization, stroke, and mortality. The frontal plane QRS-T [f(QRS-T)] angle, which is defined as the angle between the directions of ventricular depolarization (QRS-axis) and repolarization (T-axis), is a novel marker of ventricular repolarization heterogeneity. The f(QRS-T) angle is associated with adverse cardiac outcomes. In light of these findings, in this study, we aimed to investigate the potential relationship between the f(QRS-T) angle and POAF. METHODS: 180 patients who underwent CABG between August 2017 and September 2018 were included in the study retrospectively. Two groups were established as patients who preserved postoperative sinus rhythm (n=130) and those who developed POAF (n=50). The f(QRS-T) angle and all other data were compared between groups. RESULTS: The fF(QRS-T) angle (p<0.001), SYNTAX score (p=0.039), serum high-sensitivity CRP levels (p=0.026), mean age (p<0.001), electrocardiographic left ventricular hypertrophy rate (LVH) (p=0.019), and hypertension rate (p=0.007) were higher, and the mean left ventricular ejection fraction (LVEF) (p<0.001) was lower in the POAF group. Multivariable logistic regression analyses demonstrated that lower LVEF (p=0.004), LVH (p=0.041), and higher age (p=0.008) and f(QRS-T) angle (p<0.001) were independently associated with POAF. CONCLUSIONS: High f(QRS-T) angle level is closely associated with the development of POAF. The f(QRS-T) angle can be a potential indicator of POAF.

Does continuous insulin therapy reduce postoperative supraventricular tachycardia incidence after coronary artery bypass operations in diabetic patients?

OBJECTIVE: To compare continuous insulin infusion (CII) and intermittent subcutaneous insulin therapy for preventing supraventricular tachycardia. The authors propose that continuous insulin therapy is more effective to reduce supraventricular tachycardias. DESIGN: A prospective randomized study. SETTING: This study was performed in 2 different centers between April 2005 and February 2007: Gülhane Military Medical Academy and University of Süleyman Demirel. PARTICIPANTS: Two hundred diabetic patients were included in this prospective randomized study. Patients were divided into 2 groups according to their insulin therapy in 2 different centers. INTERVENTIONS: Group 1 included 100 diabetes mellitus (DM) patients, and CIIs were administrated. These patients received a CII infusion titrated per protocol in the perioperative period (Portland protocol). Group 2 also included 100 DM patients, and subcutaneous insulin was injected every 4 hours in a directed attempt to maintain blood glucose levels below 200 mg/dL. Sliding scale dosage of insulin was titrated to each patient's glycemic response during the prior 4 hours. MEASUREMENTS AND MAIN RESULTS: There were 5 hospital mortalities in the intermittent insulin group. The causes of death were pump failure in 3 patients and ventricular fibrillation in 2 patients. There were 2 hospital mortalities in the CII group (p = 0.044). Thirty-six patients in the intermittent insulin group and 21 patients in the CII group required positive inotropic drugs after cardiopulmonary bypass (p = 0.028). Low cardiac output developed in 28 and 16 patients in the intermittent and CII groups, respectively (p = 0.045). Univariate analysis identified positive inotropic drug requirement (p = 0.011, odds ratio [OR] = 3.41), ejection fraction (EF) (p = 0.001, OR = 0.92), cross-clamp time (p = 0.046, OR = 0.97), left internal mammary artery (p = 0.023, OR = 0.49), chronic obstructive pulmonary disease (COPD) (forced expiratory volume in 1 second <75% of predicted value (p = 0.009, OR = 2.02), intra-aortic balloon pump (p = 0.045, OR = 1.23), body mass index (p = 0.035 OR = 5.60), and CII (p < 0.001, OR = 0.36) as predictors of SVT. Stepwise multivariate analysis confirmed the significance of some of the previously mentioned variables as predictors of SVT. The value of -2 log likelihood of multivariate analyses was 421.504. These were EF (p < 0.001, OR = 0.91), positive inotropic drug requirement (p < 0.001, OR = 3.94), COPD (p = 0.036, OR = 2.11), and CII (p < 0.001, OR = 0.19). CONCLUSION: Continuous insulin therapy in the perioperative period reduces infectious complications, such as sternal wound infection and mediastinitis, cardiac mortality caused by pump failure, and the risk of development of supraventricular tachycardias.

Statin use before by-pass surgery decreases the incidence and shortens the duration of postoperative atrial fibrillation.

BACKGROUND: The aim of the present observational study is to search the incidence of postoperative atrial fibrillation (AF) in patients with or without preoperative statin treatment. METHODS AND RESULTS: The population consisted of 362 consecutive patients (267 on and 95 not on statin). Diabetes mellitus was more frequent in statin group (p = 0.03). Other demographic and procedural variables were similar in the both groups (All p > 0.05). Postoperative AF was less frequent and its duration was shorter in statin group compared to non-statin group (p = 0.03 and 0.0001, respectively). The Kaplan-Meier analysis showed the protective effect of statins against the risk of developing AF (p = 0.01). CONCLUSION: Statin treatment before the by-pass surgery decreases the incidence and shortens the duration of postoperative AF.

A Retrospective Study of Coronary Artery Bypass Grafting with Low-Thermal Plasma Dissection Device Compared to Conventional Monopolar Electrosurgery

Abstract Introduction: The objective of this study is to compare the effects of conventional monopolar electrosurgery (CMES) and low-thermal plasma kinetic cautery (PKC) on complications such as bleeding, abnormal wound healing, pain, and drainage in patients who underwent on-pump coronary artery bypass grafting (CABG). Methods: This retrospective clinical study included 258 patients undergoing CABG; the patients were randomized to PKC (PEAK PlasmaBlade, n=153) and CMES (n=105) groups. The patients' clinical data were examined retrospectively for biochemical variables, postoperative drainage, post-surgery erythrocyte suspension transfusion count, surgical site pain examined with visual analogue scale (VAS), and wound healing. Two-sided P-value > 0.05 was considered as statistically significant. Results: The median post-surgery erythrocyte suspension transfusion number was significantly lower with PKC compared to CMES (0 [0-1] vs. 1 [1-4], respectively, P<0.001). Mean postoperative drain output and time until removal of drain tubes were significantly lower with PKC compared to CMES (300±113 vs. 547±192 and 1.95±1.5 vs. 2.44±1.8; P<0.001 and P=0.025, respectively). Mean VAS score for spontaneous and cough-induced pain were significantly lower with PKC compared to CMES (1.98±1.51 vs. 3.94± 2.09 and 3.76±1.46 vs. 5.6±1.92; P<0.001 for both comparisons). Reoperation due to bleeding was significantly higher with CMES compared to PKC (0 vs. 11 [7.2%], P=0.001). Conclusion: Use of PKC during CABG considerably reduces postoperative drainage, need for blood transfusion, reoperation due to bleeding, and postoperative pain. PCK appears to be a good alternative to CMES for CABG.

Vascular wall damage in rats induced by organophosphorus insecticide methidathion.

We have examined the effect of subchronic methidathion (MD) administration on vascular wall damage. The experimental groups were: control group and rats treated with 5 mg/kg MD. The MD group was given MD by gavage for 5 days a week for 4 weeks at a dose level of 5 mg/kg per day by using corn oil as the vehicle. The levels of malondialdehyde (MDA) were determined in the vascular tissue. Histopathological examination was examined in the thoracic aortic tissue. The levels of MDA were increased in the MD group compared with the control group (P < 0.01). In the MD group, subchronic MD administration led to the irregulation, prominent breaks and fragmentation of the elastic fibers were located in the media of aortic wall. In conclusion, it is likely that subchronic MD administration caused vascular wall damage and, in addition, lipid peroxidation may be one of the molecular mechanisms involved in MD-induced vascular toxicity.

The validation of the atria and cha2ds2-vasc scores in predicting atrial fibrillation after coronary artery bypass surgery

Abstract Objective: The aim of this study was to evaluate the value of CHA2DS2-VASc and Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) risk scores for prediction of postoperative atrial fibrillation (AF) development in patients undergoing coronary artery bypass grafting (CABG) operation. Methods: The population of this observational study consisted of 370 patients undergoing CABG operation. CHA2DS2-VASc and ATRIA risk scores were calculated for all patients and their association with postoperative AF (AF episode lasting > 5 min) were evaluated. Predictors of postoperative AF were determined by multiple logistic regression analysis. Results: During follow-up, 110 patients (29.7%) developed postoperative AF. With multiple logistic regression analysis, risk factors for postoperative AF were determined: ATRIA risk score (odds ratio [OR] 1.23; 95% confidence interval [CI] 1.11-1.36; P<0.001), fasting glucose level (OR 1.006; 95% CI 1.004-1.009; P<0.001), and 24-hour drainage amount (OR 1.002; 95% CI; 1.001-1.004; P<0.001). Receiver operating characteristic curve analyses showed that CHA2DS2-VASc and ATRIA risk scores were significant predictors for new-onset AF (C-statistic 0.648; 95% CI 0.59-0.69; P<0.001; and C-statistic 0.664; 95% CI 0.61-0.71; P<0.001, respectively). Conclusion: CHA2DS2-VASc and ATRIA risk scores predict new AF in patients undergoing CABG.

Frontal plane QRS-T angle may be a predictor for post-coronary artery bypass graft surgery atrial fibrillation

SUMMARY BACKGROUND: New-onset postoperative atrial fibrillation (POAF) is the most common arrhythmia following coronary artery bypass graft surgery (CABG) and is associated with prolonged hospitalization, stroke, and mortality. The frontal plane QRS-T [f(QRS-T)] angle, which is defined as the angle between the directions of ventricular depolarization (QRS-axis) and repolarization (T-axis), is a novel marker of ventricular repolarization heterogeneity. The f(QRS-T) angle is associated with adverse cardiac outcomes. In light of these findings, in this study, we aimed to investigate the potential relationship between the f(QRS-T) angle and POAF. METHODS: 180 patients who underwent CABG between August 2017 and September 2018 were included in the study retrospectively. Two groups were established as patients who preserved postoperative sinus rhythm (n=130) and those who developed POAF (n=50). The f(QRS-T) angle and all other data were compared between groups. RESULTS: The fF(QRS-T) angle (p<0.001), SYNTAX score (p=0.039), serum high-sensitivity CRP levels (p=0.026), mean age (p<0.001), electrocardiographic left ventricular hypertrophy rate (LVH) (p=0.019), and hypertension rate (p=0.007) were higher, and the mean left ventricular ejection fraction (LVEF) (p<0.001) was lower in the POAF group. Multivariable logistic regression analyses demonstrated that lower LVEF (p=0.004), LVH (p=0.041), and higher age (p=0.008) and f(QRS-T) angle (p<0.001) were independently associated with POAF. CONCLUSIONS: High f(QRS-T) angle level is closely associated with the development of POAF. The f(QRS-T) angle can be a potential indicator of POAF.

RESUMO OBJETIVO: A fibrilação atrial pós-operatória de início recente (Poaf) é a arritmia mais comum após a cirurgia de revascularização do miocárdio (CABG) e associada a hospitalização prolongada, acidente vascular cerebral e mortalidade. O ângulo QRS-T [f(QRS-T)] do plano frontal, que é definido como o ângulo entre as direções da despolarização ventricular (eixo-QRS) e repolarização (eixo-T), é um novo marcador da heterogeneidade da repolarização ventricular. O ângulo f(QRS-T) está associado a desfechos cardíacos adversos. À luz desses achados, neste estudo, objetivamos investigar a relação potencial entre o ângulo f(QRS-T) e a Poaf. MéTODOS: Cento e oitenta pacientes submetidos a CABG entre agosto de 2017 e setembro de 2018 foram incluídos no estudo retrospectivamente. Dois grupos foram estabelecidos como pacientes com ritmo sinusal pós-operatório (n=130) e com Poaf (n=50). O ângulo f(QRS-T) e todos os dados foram comparados entre os grupos. RESULTADOS: Ângulo f(QRS-T) (p<0,001), escore Syntax (p=0,039), níveis séricos de PCR de alta sensibilidade (p=0,026), idade média (p<0,001), taxa de hipertrofia ventricular esquerda eletrocardiográfica (LVH) (p=0,019) e taxa de hipertensão (p=0,007) foram maiores; a fração de ejeção média do ventrículo esquerdo (LVEF) (p<0,001) foi menor no grupo com Poaf. As análises de regressão logística multivariável demonstraram que menor LVEF (p=0,004), LVH (p=0,041), maior idade (p=0,008) e maior ângulo f(QRS-T) (p<0,001) foram independentemente associados à Poaf. CONCLUSÕES: Níveis de ângulo altos f(QRS-T) estão intimamente associados à Poaf. O ângulo f(QRS-T) pode ser um indicador potencial de Poaf.

Cardiotoxicity in rats induced by methidathion and ameliorating effect of vitamins E and C.

We have examined the effect of subchronic methidathion (MD) administration on heart damage, and have evaluated possible ameliorating effects of a combination of vitamins E and C against MD toxicity. The experimental groups were: control group, rats treated with 5 mg/kg MD and rats treated with 5 mg/kg body weight MD plus vitamin E and vitamin C (MD+Vit). The groups were given MD by gavage 5 days a week for four weeks at a dose level of 5 mg/kg/day (MD and MD+Vit) by using corn oil as the vehicle. Vitamin E and vitamin C were injected at doses of 50 mg/kg i.m. and 20 mg/kg i.p., respectively, after the treatment with MD in the MD+ Vit group. The levels of malondialdehyde (MDA) were determined in the heart tissue, and the levels of cardiac troponin I (TnI) in serum. An autoanalyser was used to determine the serum activities of cholinesterase (ChE). Histopathological examination was carried out in the heart tissue. MDA significantly increased in the MD group as compared to controls (P <0.01). When MD was given concurrently with vitamins E and C, the increase in MDA was significantly less (P <0.01). ChE activity significantly decreased in the MD group as compared to controls (P <0.01). When MD was given concurrently with vitamins E and C, the decrease in ChE activity was significantly higher (P <0.05). The serum TnI levels significantly increased in the MD group as compared to controls (P <0.01). When MD was given concurrently with vitamins E and C, the increase in the serum TnI was significantly less (P <0.01). MD caused the diffuse loss of striation and myocytolysis of the cardiomyocytes, whereas the combination of vitamins E and C caused a significant decrease in these effects of MD. In conclusion, subchronic MD administration caused heart damage and, in addition, treatment with a combination of vitamins E and C after the administration of MD reduced heart damage caused by MD.

Association between the use of non-antiarrhythmic drugs and postoperative atrial fibrillation.

PURPOSE: To evaluate the association between statins, N-acetylcysteine (NAC) and angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) and postoperative atrial fibrillation (AF). METHODS: A total of 590 patients undergoing coronary artery bypass and/or valve surgery were studied. An AF episode lasting >5 min during hospitalization was accepted as endpoint. RESULTS: AF rate was 18% (n=106). Multivariable positive predictors of AF included age ≥ 65, left atrial diameter ≥ 45 mm, cross clamp time; negative predictors included use of left internal mammarian artery, NAC, and ACEIs or ARBs. CONCLUSIONS: ACEIs or ARBs and NAC is associated with low incidence of postoperative AF, however, this association was not found with statin or combined use these agents.

Association between renin-angiotensin-aldosterone system blockers and postoperative atrial fibrillation in patients with mild and moderate left ventricular dysfunction.

OBJECTIVE: The aim of the study was to evaluate the association between renin - angiotensin - aldosterone system blockers and risk of postoperative atrial fibrillation (AF) development in patients with mild and moderate left ventricular systolic dysfunction. METHODS: The population of this prospective and observational study consisted of 269 patients with an ejection fraction of < or = 50% undergoing coronary artery bypass and/or valve surgery. Use of renin -angiotensin-aldosterone system blockers (angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB) and spironolactone) and their association with postoperative AF (AF episode lasting < or = 5 min) were evaluated. In statistical analysis t test for independent samples, Chi-square test and Mann Whitney U test were used for comparison of variables between groups. Predictors of postoperative AF were determined by multiple logistic regression analysis. RESULTS: During follow-up, 50 patients (13%) developed postoperative AF. With multiple logistic regression analysis, risk factors for postoperative AF were determined: left atrial diameter (OR- 1.09; 95%CI 1.01-1.16, p=0.02), age (OR-1.04; 95%CI 1.002- 1.08, p=0.04), aortic cross-clamp duration (OR- 1.03, 95%CI -1.00-1.05, p=0.01), use of left internal mammarian artery (OR-0.33; 95%CI 0.13-0.88, p=0.03), ACEIs treatment (OR-0.27; 95%CI 0.12-0.62, p=0.002), and ARBs treatment (OR - 0.21, 95%CI 0.07-0.62, p=0.005). CONCLUSIONS: Our results indicate that although treatments with ACEIs and ARBs are associated with low incidence of postoperative AF in patients with mild and moderate left ventricular systolic dysfunction, treatment with spironolactone is not.

Effect of renin-angiotensin aldosteron system blockers on postoperative atrial fibrillation.

BACKGROUND: No randomized studies have been conducted to evaluate the effects of renin-angiotensin aldosteron system blockers on postoperative atrial fibrillation (AF). The aim of this study was to evaluate the effect of angiotensin converting-enzyme inhibitors (ACEIs) and ACEI plus candesartan, an angiotensin receptor blocker on postoperative AF. METHODS: A group of consecutive patients undergoing coronary artery bypass and/or valve surgery was studied (n=128). The patients were randomized to ACEI group (n=49) and ACEI plus candesartan group (n=49). Thirty patients not on ACEI or angiotensin receptor blocker constituted the control group. RESULTS: The rate of postoperative AF was higher in the control group (33.3%) compared to the ACEI group (12.2%, p=0.02) or ACEI plus candesartan group (10.2%, p=0.01). With the Cox proportional model, univariable negative predictors of postoperative AF, were the use of ACEI (RR 0.34, 95% CI 0.12 to 0.93, p=0.03) and the use of ACEI plus candesartan (RR 0.28, 95% CI 0.09 to 0.83, p=0.02); the positive predictor of postoperative AF was age>or=65 (RR 3.10, 95% CI 1.30 to 7.37, p=0.01). With the multivariable Cox proportional model, the only predictor of postoperative AF was age>or=65 (RR 9.70, 95% CI 2.04 to 46.1, p=0.004). CONCLUSION: ACEI alone and ACEI plus candesartan decrease the incidence of postoperative AF compared to the control group. Candesartan has no additional effect on the rates of postoperative AF when added to ACEI.

N-acetylcysteine for the prevention of postoperative atrial fibrillation: a prospective, randomized, placebo-controlled pilot study.

AIMS: Oxidative stress has recently been implicated in the pathophysiology of atrial fibrillation (AF). The aim of the present study was to evaluate the effects of antioxidant agent N-acetylcysteine (NAC) on postoperative AF. METHODS AND RESULTS: The population of this prospective, randomized, double-blind, placebo-controlled study consisted of 115 patients undergoing coronary artery bypass and/or valve surgery. All the patients were treated with standard medical therapy and were randomized to NAC group (n = 58) or placebo (saline, n = 57). An AF episode >5 min during hospitalization was accepted as endpoint. During follow-up period, 15 patients (15/115, 13%) had AF. The rate of AF was lower in NAC group compared with placebo group (three patients in NAC group [5.2%] and 12 patients in placebo group [21.1%] had postoperative AF; odds ratio [OR] 0.20; 95% confidence interval [CI] 0.05 to 0.77; P = 0.019). In the multivariable logistic regression analysis, independent predictors of postoperative AF were left atrial diameter (OR, 1.18; 95% CI, 1.06-1.31; P = 0.002) and the use of NAC (OR, 0.20; 95% CI, 0.04-0.91; P = 0.038). CONCLUSION: The result of this study indicates that NAC treatment decreases the incidence of postoperative AF.

Inverse relationship between adiponectin levels and subclinical carotid atherosclerosis in patients undergoing coronary artery bypass grafting.

The purpose of this study was to examine the relation between adiponectin levels and subclinical carotid atherosclerosis in patients undergoing coronary artery bypass grafting (CABG). Serum concentrations of adiponectin and carotid intima/media thickness (IMT) were measured in 84 consecutive patients who underwent CABG. Carotid IMT both at the common carotid artery and carotid bulb level was correlated negatively and significantly (r = -0.581 and r = -0.415, respectively, P < 0.01) with the serum concentrations of adiponectin. Linear regression modeling identified adiponectin as the strongest predictive variable for carotid IMT both at the common carotid artery and carotid bulb level (P < 0.001). Stepwise regression analyses also showed that adiponectin was the strongest independent determinant of the carotid IMT both at the common carotid artery and the carotid bulb level (F = 20.215 and F = 19.565, respectively, P < 0.001). The mean number of diseased coronary arteries, mean number of distal anastomoses, cardiopulmonary bypass time, and aortic cross-clamping time did not significantly correlate with the serum concentrations of adiponectin. The findings indicate the presence of an inverse relationship between serum concentrations of adiponectin and subclinical carotid atherosclerosis in patients undergoing CABG. In these patients, the absence of a significant correlation between severity of coronary atherosclerosis and adiponectin might suggest that adiponectin levels may predict the early stages rather than further progression of atherosclerosis.

Left atrial myxoma associated with acute myocardial infarction.

A 38-year-old male was admitted to our institution with left atrial myxoma complicated with acute myocardial infarction. The patient had no risk factor for coronary artery disease. A transthoracic echocardiographic study revealed the presence in the left atrium of an echogenic, mobile mass, compatible with myxoma. There were no endocrine hyperactivity, any other tumor and family history. Coronary angiography revealed normal coronary arteries and aorto-coronary bypass surgery was not required in this patient. The tumor was successfully removed surgically. In conclusion, there could be no other etiologic possibility identified and therefore left atrial tumor causing coronary embolization and MI was considered the most likely event in this patient.

Beneficial effect of the addition of nitroglycerin to the cardioplegic solution on lipid peroxidation during coronary artery bypass surgery.

The effects of the addition of a nitric oxide (NO) donor to the cardioplegic solution on reperfusion injury and lipid peroxidation (LPO) in coronary artery bypass grafting (CABG) are not known. Therefore, this work was conducted to determine the possible effects of nitroglycerin on LPO and reperfusion injury as a result of CABG. A prospective double-blind, placebo-controlled study was conducted in 30 consecutive patients with coronary artery disease who underwent CABG with cardiopulmonary bypass. The patients were randomly assigned to receive 3 microg/kg of nitroglycerin added to the cardioplegic solution (NTG group) or 3 microg/kg of placebo added to the cardioplegic solution (placebo group). MDA increased significantly in the placebo group compared to the NTG group during the ischemic (P < 0.01) and reperfusion periods (P < 0.01). The level of troponin I decreased significantly in the NTG group compared to the placebo group during the ischemic and reperfusion periods (P < 0.001). The level of NO increased significantly in the NTG group compared to the placebo group during the ischemic and reperfusion periods (P < 0.01). LPO was increased in response to CPB during CABG, together with simultaneous decreases in serum nitric oxide levels, whereas LPO was significantly decreased in response to CPB with nitroglycerin, together with simultaneous increases in the levels of serum nitric oxide.