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Post-operative atrial fibrillation is influenced by beta-blocker therapy but not by pre-operative atrial cellular electrophysiology

By A.J. Workman, D. Pau, C.J. Redpath, G.E. Marshall, J.A. Russell, K.A. Kane, J. Norrie and A.C. Rankin

Abstract

<b>Introduction:</b> We investigated whether post-cardiac surgery (CS) new-onset atrial fibrillation (AF) is predicted by pre-CS atrial cellular electrophysiology, and whether the antiarrhythmic effect of beta-blocker therapy may involve pre-CS pharmacological remodeling.\ud \ud <b>Methods and Results:</b> Atrial myocytes were obtained from consenting patients in sinus rhythm, just prior to CS. Action potentials and ion currents were recorded using whole-cell patch-clamp technique. Post-CS AF occurred in 53 of 212 patients (25%). Those with post-CS AF were older than those without (67 ± 2 vs 62 ± 1 years, P = 0.005). In cells from patients with post-CS AF, the action potential duration at 50% and 90% repolarization, maximum upstroke velocity, and effective refractory period (ERP) were 13 ± 4 ms, 217 ± 16 ms, 185 ± 10 V/s, and 216 ± 14 ms, respectively (n = 30 cells, 11 patients). Peak L-type Ca<sup>2+</sup> current, transient outward and inward rectifier K<sup>+</sup> currents, and the sustained outward current were −5.0 ± 0.5, 12.9 ± 2.4, −4.1 ± 0.4, and 9.7 ± 1.0 pA/pF, respectively (13-62 cells, 7-19 patients). None of these values were significantly different in cells from patients without post-CS AF (P &#62; 0.05 for each, 60-279 cells, 29-86 patients), confirmed by multiple and logistic regression. In patients treated &#62;7 days with a beta-blocker pre-CS, the incidence of post-CS AF was lower than in non-beta-blocked patients (13% vs 27%, P = 0.038). Pre-CS beta-blockade was associated with a prolonged pre-CS atrial cellular ERP (P = 0.001), by a similar degree (~20%) in those with and without post-CS AF.\ud \ud <b>Conclusion:</b> Pre-CS human atrial cellular electrophysiology does not predict post-CS AF. Chronic beta-blocker therapy is associated with a reduced incidence of post-CS AF, unrelated to a pre-CS ERP-prolonging effect of this treatment

Topics: QP
Publisher: Blackwell
Year: 2006
DOI identifier: 10.1111/j.1540-8167.2006.00625.x
OAI identifier: oai:eprints.gla.ac.uk:4901
Provided by: Enlighten

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