Plasma Catecholamine Levels on the Morning of Surgery Predict Post-Operative Atrial Fibrillation

• Published in: JACC. Clinical electrophysiology Vol. 3; no. 12; pp. 1456 - 1465
• Main Authors: Anderson, Ethan J., PhD, Efird, Jimmy T., PhD, MSc, Kiser, Andy C., MD, Crane, Patricia B., PhD, RN, O’Neal, Wesley T., MD, MPH, Ferguson, T. Bruce, MD, Alwair, Hazaim, MD, Carter, Kendal, Williams, J. Mark, MD, Gehi, Anil K., MD, Kypson, Alan P., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 11.12.2017
• Subjects: Aged; Aortic Valve - surgery; Atrial Fibrillation - diagnosis; Atrial Fibrillation - epidemiology; Atrial Fibrillation - physiopathology; Atrial Fibrillation - prevention & control; Cardiac Surgical Procedures - adverse effects; Cardiopulmonary Bypass - adverse effects; Cardiovascular; catecholamine; Catecholamines - blood; Coronary Artery Bypass - adverse effects; Elective Surgical Procedures; Female; heart surgery; Humans; Male; Middle Aged; Monoamine Oxidase - blood; post-operative atrial fibrillation; Postoperative Complications - epidemiology; Predictive Value of Tests; Preoperative Period; sympathetic activation; norepinephrine; post-operative atrial fibrillation; POAF; HTN; heart surgery; PACU; myocardial infarction; angiotensin receptor blocker; peri-anesthesia care unit; ratio of early to late ventricular filling velocities across the mitral valve; atrial fibrillation; electrocardiogram; angiotensin converting enzyme inhibitor; not fourth quartile; intensive care unit; MI; monoamine oxidase; heart failure; CCB; Q 4; AF; ECG; epinephrine; MV E/A; fourth quartile; ARB; LOS; catecholamine; sympathetic activation; calcium channel blocker; enzyme-linked immunosorbent assay; NE; ACEi; length of stay; ICU; MAO; DA; dopamine; hypertension; HF; COPD; chronic obstructive pulmonary disease; ELISA; EPI; Q4
• ISSN: 2405-500X; 2405-5018
• DOI: 10.1016/j.jacep.2017.01.014

Abstract Objectives This study sought to determine whether plasma catecholamines and monoamine oxidase-B (MOA-B) are associated with post-operative atrial fibrillation (POAF) in patients undergoing elective cardiac surgery. Background Although intra- and post-operative adrenergic tone has been demonstrated to be an causative factor for POAF, the role and association of pre-operative plasma catecholamines remains unclear. Methods Prior to administration of anesthesia on the morning of surgery, blood samples were obtained from 324 patients undergoing nonemergent coronary artery bypass graft and/or aortic valve surgery with cardiopulmonary bypass at East Carolina Heart Institute. The concentrations of norepinephrine (NE), dopamine (DA), epinephrine (EPI), and enzyme MAO-B were assessed in platelet-rich plasma. A log-binomial regression model was used to determine the association between quartiles of these variables and POAF. Results Levels of NE (p = 0.0006) and EPI (p = 0.047) in the 4th quartile ( Q 4 NE + ) were positively associated with POAF, whereas DA (p = 0.0034) levels in the 4th quartile ( Q 4 DA + ) were inversely associated with POAF. Adjusting for age, heart failure (HF), and history of atrial fibrillation, the composite pre-operative (adrenergic) plasma marker ( Q 4 NE +   V   Q 4 DA − ) was associated with a 4-fold increased occurrence of POAF (adjusted p = 0.0001). No association between plasma MAO-B and POAF was observed. Conclusions Our results suggest that pre-operative adrenergic tone is an important factor underlying POAF. This information provides evidence that assessment of plasma catecholamines may be a low-cost method that is easy to implement for predicting which patients are likely to develop POAF. More investigation in a multicentric setting is needed to validate our results.