Postoperative atrial fibrillation in cardiac surgery: an approach to the mechanism and protection.

2019 Fiscal Year Final Research Report

• Project/Area Number: 16K10643
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Cardiovascular surgery
• Research Institution: Nippon Medical School
• Principal Investigator: IMURA HAJIME 日本医科大学, 医学部, 准教授 (40281422)
• Project Period (FY): 2016-04-01 – 2020-03-31
• Keywords: 心房細動 / 開心術 / 電気生理学検査 / 術後合併症 / ペーシング

Outline of Final Research Achievements

We investigated where and how postoperative atrial fibrillation (POAF) occurred in the atrium after cardiac surgeries. Electric potentials of the left and right atrium (RA and LA) were monitored through five pacing leads (upper and lower RA, Bachmann bundle on the atrial septum (BB), and lateral walls of LA near the lower pulmonary veins) in 41 patients who underwent valve surgeries. POAF was seen in 16 patients (39%), and POAF was recorded via the leads in 12 patients. Mean duration between surgery and POAF was 3.5 days. Six POAF started from the left LA (most frequent). In pacing study (100/min) at BB lead, the conductivities to other 4 leads (duration between pacing spike and atrial potential at the 4 leads) were significantly delayed (p<0.05) before cardiopulmonary bypass in POAF patients. Thus, this study demonstrated that simple pacing study might be useful to identify patients who were at high risk of POAF.

Free Research Field

心臓血管外科

Academic Significance and Societal Importance of the Research Achievements

心臓手術後心房細動ではこれまで複数の素因(年齢や肥満、CT所見など)が報告されているが特異性に問題があった。我々の行った電気生理学検査によるアプローチは感度と特異性に優れる可能性があり、より有効にPOAF発生を予測する可能性がある。的確なPOAF発生の予想は、その予防に貢献し、医療費の軽減に寄与することが期待される。