Abstract 12120: A Greater Increase of Perioperative Fatty Acid Binding Protein Levels is Associated with Atrial Fibrillation After Cardiac Surgery
Background: Postoperative atrial fibrillation (AF) is the most common arrhythmic complication after cardiac surgery, yet its underlying mechanisms remain poorly understood. Fatty acid binding protein (FABP) is a sensitive marker of myocardial ischemia and cell damage and perioperative serum levels may be associated with AF.
Methods: In a pilot study of 63 hospitalized, high-risk patients undergoing coronary artery bypass grafting, valve surgery or both, we measured FABP before and up to 4 days after surgery until AF occurred.
Results: Thirty five (56%) of 63 patients developed postoperative AF before hospital discharge. AF occurred most commonly on day 3 (46%) and 2 (26%) after surgery. Patients who developed AF were older and underwent more frequently valve surgery compared to those who remained in sinus rhythm. Preoperative FABP levels were similar in patients with AF compared to patients without AF (median level 3459 ng/ml, interquartile range [IQR] 2123-5410 vs. 3098, IQR 1883-3975, p=0.11). Patients with vs. without AF had a markedly greater increase of FABP levels after surgery (Figure 1). This difference was statistically significant for postoperative day 1 (p=0.029) and 2 (p=0.019), but not day 3 and 4. After controlling for age, type of surgery, left ventricular ejection fraction, left atrial size and preoperative beta blocker use, only age (OR 4.1 (95% CI 1.45-12.15) and FABP levels on postoperative day 2 (OR 2.63 (95% CI 1.05-7.02) independently predicted occurrence of postoperative AF.
Conclusions: A greater rise in fatty acid binding protein levels is seen in patients who develop AF after cardiac surgery. Although our pilot study is limited by low statistical power, myocardial damage during cardiac surgery is a plausible novel mechanism of postoperative AF and should be further studied.
- © 2011 by American Heart Association, Inc.