Volume 13 Supplement 1
When should we discontinue antiarrhythmic therapy for atrial fibrillation after abdominal surgery?
© Pagano et al; licensee BioMed Central Ltd. 2013
Published: 16 September 2013
Aim of the study
The purpose of this study was to determine whether the duration of antiarrhythmic therapy after discharge from the hospital following abdominal surgery is related to the incidence of atrial fibrillation (AF) recurrence in elderly patients with the occurrence of peri-operative AF.
The occurrence of peri-operative AF after abdominal surgery is a clinical condition burdened by several complications, especially in the elderly [1–3]. When AF is successfully converted to sinus rhythm, it is unlikely to recur, and nearly all of these patients are discharged from the hospital in sinus rhythm. It is not clear how soon these patients may discontinue antiarrhythmic therapy to avoid drugs side effects without risking recurrence of AF.
The recurrence of AF needs different kind of treatment. Medical therapy includes various antiarrhythmic drugs to control heart rate and restore sinus rhythm and anticoagulation to reduce the tromboembolic risk . Overactivation of sympathetic nervous system, related to surgery stress , could be reduced by the treatment with antiarrhythmic drugs, such as Beta Blockers, and may reduce the incidence of AF recurrence [6–10].
A pilot study was conducted in 19 elderly patients (age > 65 years) who underwent abdominal surgery (right emicolectomy, sigmoidectomy and anterior rectal resection) and with occurrence of peri-operative AF that successfully reverted to sinus rhythm. They were prospectively randomized at dismissal to receive antiarrhythmic therapy for 1 week (six patients in group A), 3 weeks (seven patients in group B), or 6 weeks (six patients in group C). Patients were followed up for an additional 4 weeks after discontinuation of antiarrhythmic therapy for detection of recurrence of AF.
There was no significant difference in the recurrence of AF among groups (0%, 2%, and 0% for groups A, B, and C, respectively).
In elderly patients with peri-operative AF after abdominal surgery, converted to normal sinus rhythm before hospital discharge, have a benign course and the duration of antiarrhythmic therapy shorter than one week is appropriate.
- Rengo F, Parisi V, Rengo G, Femminella GD, Rengo C, Zincarelli C, Pagano G, Festa G, De Lucia C, Leosco D: Instruments for geriatric assessment: new multidimensional assessment approaches. JOURNAL OF NEPHROLOGY. 2012, 25: 73-78. 10.5301/jn.5000164. ISSN: 1121-8428, doi: 10.5301/jn.5000164View ArticleGoogle Scholar
- Pilotto A, Addante F, Franceschi M, Leandro G, Rengo G, D’Ambrosio P, Longo MG, Rengo F, Pellegrini F, Dallapiccola B, Ferrucci L: A Multidimensional Prognostic Index (MPI) based on a Comprehensive Geriatric Assessment Predicts Short-Term Mortality in Older Patients with Heart Failure. Circulation: Heart Failiure. 2010, 3: 14-20. 10.1161/CIRCHEARTFAILURE.109.865022.Google Scholar
- Rispoli C, Rocco N, Iannone L, Amato B: Developing guidelines in geriatric surgery: role of the grade system. BMC Geriatrics. 2009, 9 (SUPPL.1): A99-Google Scholar
- Rengo G, Pagano G, Squizzato A, Moja L, Femminella GD, de Lucia C, Komici K, Parisi V, Savarese G, Ferrara N, Perrone-Filardi P, Leosco D: Oral anticoagulation therapy in heart failure patients in sinus rhythm: a systematic review and meta-analysis. PloS One. 2013, 8 (1): e52952-10.1371/journal.pone.0052952. doi:10.1371/journal.pone.0052952PubMed CentralView ArticlePubMedGoogle Scholar
- Paolillo S, Rengo G, Pagano G, Pellegrino T, Savarese G, Femminella GD, Tuccillo , Boemio A, Attena E, Formisano R, Petraglia L, Scopacasa F, Galasso G, Leosco D, Trimarco B, Cuocolo A, Perrone-Filardi P: Impact of Diabetes Mellitus on Cardiac Sympathetic Innervation in Patients With Heart Failure. A Iodine-123 meta-iodobenzylguanidine (I123MIBG) Scintigraphic Study. Diabetes Care. 2013Google Scholar
- Rengo G, Lymperopoulos A, Zincarelli C, Femminella Gd, Liccardo D, Pagano G, de Lucia C, Cannavo A, Gargiulo P, Ferrara N, Perrone Filardi P, Koch Wj, Leosco D: Blockade of beta-adrenoceptors restores the GRK2-mediated adrenal alpha(2) -adrenoceptor-catecholamine production axis in heart failure. BRITISH JOURNAL OF PHARMACOLOGY. 2012, 166: 2430-2440. 10.1111/j.1476-5381.2012.01972.x. ISSN: 1476-5381, doi: 10.1111/j.1476-5381.2012.01972.xPubMed CentralView ArticlePubMedGoogle Scholar
- Rengo G, Zincarelli C, Femminella GD, Liccardo D, Pagano G, de Lucia C, Altobelli GG, Cimini V, Ruggiero D, Perrone-Filardi P, Gao E, Ferrara N, Lymperopoulos A, Koch WJ, Leosco D: Myocardial beta(2) -adrenoceptor gene delivery promotes coordinated cardiac adaptive remodelling and angiogenesis in heart failure. BRITISH JOURNAL OF PHARMACOLOGY. 2012, 166: 2348-2361. 10.1111/j.1476-5381.2012.01954.x. ISSN: 1476-5381, doi: 10.1111/j.1476-5381.2012.01954.xPubMed CentralView ArticlePubMedGoogle Scholar
- Rengo G, Perrone-Filardi P, Femminella GD, Liccardo D, Zincarelli C, de Lucia C, Pagano G, Marsico F, Lymperopoulos A, Leosco D: Targeting the beta-adrenergic receptor system through G-protein-coupled receptor kinase 2: a new paradigm for therapy and prognostic evaluation in heart failure: from bench to bedside. CIRCULATION. HEART FAILURE. 2012, 5: 385-391. 10.1161/CIRCHEARTFAILURE.112.966895. ISSN: 1941-3289, doi: 10.1161/CIRCHEARTFAILURE.112.966895View ArticlePubMedGoogle Scholar
- Rengo G, Leosco D, Zincarelli C, Marchese M, Corbi G, Liccardo D, Filippelli A, Ferrara N, Lisanti MP, Koch WJ, Lymperopoulos A: Adrenal GRK2 lowering is an underlying mechanism for the beneficial sympathetic effects of exercise training in heart failure. American Journal of Physiology - Heart and Circulatory Physiology. 2010, 24 (9):Google Scholar
- Leosco D, Rengo G, Iaccarino G, Golino L, Marchese M, Fortunato F, Zincarelli C, Sanzari E, Ciccarelli M, Galasso G, Altobelli GG, Conti V, Matrone G, Cimini V, Ferrara N, Filippelli A, Koch WJ, Rengo F: Exercise promotes angiogenesis and improves β-adrenergic receptor signalling in the post-ischaemic failing rat heart. Cardiovascular Research. 2008, 30 (3):Google Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.