Author + information
- Panagiotis Korantzopoulos, MD⁎ ( )(, )
- Theofilos M. Kolettis, MD, PhD and
- John A. Goudevenos, MD, FACC, FESC
- ↵⁎Department of Internal Medicine, Division of Cardiology, University of Ioannina Medical School, 45110 Ioannina, Greece
We read with considerable interest the recent contribution by Calò et al. (1) about the reduced incidence of postoperative atrial fibrillation (AF) after administration of n-3 polyunsaturated fatty acids (PUFAs) in patients undergoing coronary artery bypass surgery (CABG). Even though the investigators discuss the potential role of inflammation in this setting we consider that some important issues merit further clarification.
First, 19 of the studied patients were subjected to off-pump surgery, a procedure considered to be associated with a lesser oxidative and inflammatory response (2). Bearing in mind the hypothesis that postoperative AF may be reduced by off-pump CABG (3), it would be meaningful to examine whether there was a difference in the incidence of postoperative AF in this subset of patients.
In addition, it has been observed that the peak incidence of AF on the second or third postoperative day coincides with the peak of inflammatory markers such as C-reactive protein (CRP) and complement-CRP complexes (4). Recently, Abdelhadi et al. (5) confirmed this association, demonstrating a more pronounced and prolonged increase in white blood cell counts of patients who developed postoperative AF. Thus, to validate the anti-inflammatory effects of PUFAs someone could investigate the variation of simple inflammatory indexes in the postoperative period. If Calò et al. have some available data on this issue it would be of interest to perform comparisons between the two groups.
Of note, more than one-half the total study population was taking statins perioperatively (1). Even though there were no differences regarding statin administration between the studied groups, the investigators could mention some data on potential differences in the incidence of postoperative AF within each group. Statins may exert beneficial pleiotropic effects on atrial remodeling, reducing the burden of the arrhythmia. It has also been indicated that statin therapy reduces the incidence of arrhythmias after CABG, although no specific data on AF was reported (6). Recently, Auer et al. (7) demonstrated a reduced incidence of AF after cardiac operation in patients receiving statins, but 44.7% of these had been subjected to valve surgery.
Accumulating evidence suggests that inflammation augments oxidative stress and vice versa, whereas oxidative stress seems to play an important role in atrial remodeling (2,8). Specifically, it has been shown that oral vitamin C administration significantly reduces the incidence of postoperative AF in CABG patients (8). Taking into account that PUFAs can attenuate oxidative stress in humans (9), it is reasonable to assume that their antioxidant action may contribute to their favorable effect on postoperative AF.
Finally, we concur with the view of Calò et al. that administration of PUFAs merits further evaluation in other forms of AF, but, as suggested by a recent study that reported no association between PUFA consumption from fish and the risk of AF (10), careful selection of the studied population should be performed.
- American College of Cardiology Foundation
- Calò L.,
- Bianconi L.,
- Colivicchi F.,
- et al.
- Archbold R.A.,
- Curzen N.P.
- Bruins P.,
- te Velthuis H.,
- Yazdanbakhsh A.P.,
- et al.
- Auer J.,
- Weber T.,
- Berent R.,
- et al.,
- European Society of Cardiology Annual Congress, Munich
- Carnes C.A.,
- Chung M.K.,
- Nakayama T.,
- et al.
- Frost L.,
- Vestergaard P.