Atrial fibrillation after coronary artery bypass grafting is associated with sympathetic activation
Atrial fibrillation after coronary artery bypass grafting is associated with sympathetic activation
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DOI：
10.1016/0003-4975(95)00718-0
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发表时间：
1995-12-01
影响因子：
4.6
通讯作者：
Tonkin, AM
中科院分区：
文献类型：
--
作者：
Kalman, JM;Munawar, M;Tonkin, AM
背景我们前瞻性研究了交感神经激活在冠状动脉旁路移植术后房颤病因中的作用。对131例冠状动脉旁路移植术后患者进行了80小时连续动态监测。术前及术后48小时每4小时测定右心房血浆去甲肾上腺素水平。在131例患者中，50%（65例）发生房颤，36%（47例）需要治疗。房颤发作前窦性心率和心房异位活动显著增加。多变量logistic回归分析显示，术后平均去甲肾上腺素水平升高（5.78 +/- 2.83 vs 3.57 +/- 1.31 nmol/L; p < 0.0001），年龄增加（68.9 +/- 5.7 vs 63.8 +/- 8.7岁; p = 0.02），术后镁水平降低（0.79 +/- 0.09 vs 0.83 +/- 0.10 mmol/L; p = 0.02）与房颤的发生独立相关。升高的去甲肾上腺素水平表明交感神经激活可能在冠状动脉旁路移植术后房颤的发病机制中起重要作用，这强调了β-肾上腺素受体阻滞剂作为预防的重要性。
Background. We prospectively investigated the role of sympathetic activation in the etiology of atrial fibrillation following coronary artery bypass grafting.Methods. Continuous ambulatory monitoring was performed for 80 hours in 131 patients after coronary artery bypass grafting. Right atrial plasma norepinephrine levels were assessed preoperatively and every 4 hours for 48 hours postoperatively.Results. Of the 131 patients, 50% (65) had development of atrial fibrillation and 36% (47) required treatment. Onset of atrial fibrillation was preceded by a significant increase in sinus rate and atrial ectopic activity. On multivariate logistic regression, elevated mean postoperative norepinephrine levels (5.78 +/- 2.83 versus 3.57 +/- 1.31 nmol/L; p < 0.0001), increased age (68.9 +/- 5.7 versus 63.8 +/- 8.7 years; p = 0.02), and decreased postoperative magnesium levels (0.79 +/- 0.09 versus 0.83 +/- 0.10 mmol/L; p = 0.02) were independently associated with the occurrence of atrial fibrillation.Conclusions. Elevated norepinephrine levels suggest that sympathetic activation may be important in the pathogenesis of atrial fibrillation after coronary artery bypass grafting, and this underlines the importance of beta-adrenoceptor blockade as prophylaxis.