Original Article

Relationship between Vitamin D Levels and the Incidence of Post Coronary Artery Bypass Graft Surgery Atrial Fibrillation

Abstract

Background: Postoperative atrial fibrillation (POAF) is probably a consequence of inflammation. Vitamin D is known for its anti-inflammatory properties. The aim of this study was to evaluate the effects of vitamin D levels on the incidence of POAF.
Methods: In a prospective cohort study, patients were monitored for the occurrence of POAF during the first 5 days after coronary artery bypass grafting surgery in Tehran Heart Center. Those with concomitant valvular surgeries were excluded. Thereafter, they were divided into 2 groups: with or without POAF. Vitamin D levels were assessed in all the patients. The relationship between the vitamin D level and the incidence of POAF was evaluated and compared between the groups using the Mann–Whitney U test.
Results: The study population comprised of 156 patients. The mean age was 62.8±8.6 years, and 105 (67.3%) patients were male. Of the 156 patients, 29 (19%) developed POAF. The median preoperative vitamin D level was 15.3 in the group with POAF and 25.3 in the group without POAF (P=0.07).
Conclusion: Our results demonstrated no significant relationship between vitamin D levels and the occurrence of POAF.

-Lauer MS, Eagle KA, Buckley MJ, DeSanctis RW. Atrial fibrillation following coronary artery bypass surgery. Progress in cardiovascular diseases. 1989 Mar 1;31(5):367-78.

-Invest EJ. Inflammation in New-onset Atrial Fibrillation after Cardiac Surgery: A Systematic Review. Inflammatory Complications after Cardiac Surgery. 2017;44(4):25.

-Bruins P, te Velthuis H, Yazdanbakhsh AP, Jansen PG, Van Hardevelt FW, de Beaumont EM, Wildevuur CR, Eijsman L, Trouwborst A, Hack CE. Activation of the complement system during and after cardiopulmonary bypass surgery. Circulation. 1997 Nov 18;96(10):3542-8.

-Gaudino M, Andreotti F, Zamparelli R, Di Castelnuovo A, Nasso G, Burzotta F, Iacoviello L, Donati MB, Schiavello R, Maseri A, Possati G. The− 174G/C interleukin-6 polymorphism influences postoperative interleukin-6 levels and postoperative atrial fibrillation. Is atrial fibrillation an inflammatory complication?. Circulation. 2003 Sep 9;108(10 suppl 1):II-195.

-Chung MK, Martin DO, Sprecher D, Wazni O, Kanderian A, Carnes CA, Bauer JA, Tchou PJ, Niebauer MJ, Natale A, Van Wagoner DR. C-reactive protein elevation in patients with atrial arrhythmias. Circulation. 2001 Dec 11;104(24):2886-91.

-Aviles RJ, Martin DO, Apperson-Hansen C, Houghtaling PL, Rautaharju P, Kronmal RA, Tracy RP, Van Wagoner DR, Psaty BM, Lauer MS, Chung MK. Inflammation as a risk factor for atrial fibrillation. Circulation. 2003 Dec 16;108(24):3006-10.

-Abdelhadi RH, Gurm HS, Van Wagoner DR, Chung MK. Relation of an exaggerated rise in white blood cells after coronary bypass or cardiac valve surgery to development of atrial fibrillation postoperatively. The American journal of cardiology. 2004 May 1;93(9):1176-8.

-Anselmi A, Possati G, Gaudino M. Postoperative inflammatory reaction and atrial fibrillation: simple correlation or causation?. The Annals of thoracic surgery. 2009 Jul 31;88(1):326-33.

-Hak Ł, Myśliwska J, Wi ckiewicz J, Szyndler K, Siebert J, Rogowski J. Interleukin-2 as a predictor of early postoperative atrial fibrillation after cardiopulmonary bypass graft (CABG). Journal of Interferon and Cytokine Research. 2009 Jun 1;29(6):327-32.

-Andrews TC, Reimold SC, Berlin JA, Antman EM. Prevention of supraventricular arrhythmias after coronary artery bypass surgery. A meta-analysis of randomized control trials.

-Echahidi N, Pibarot P, O’Hara G, Mathieu P. Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery. Journal of the American College of Cardiology. 2008 Feb 26;51(8):793-801.

-Ramlawi B, Otu H, Mieno S, Boodhwani M, Sodha NR, Clements RT, Bianchi C, Sellke FW. Oxidative stress and atrial fibrillation after cardiac surgery: a case-control study. The Annals of thoracic surgery. 2007 Oct 31;84(4):1166-73.

-Perrier S, Meyer N, Minh TH, Announe T, Bentz J, Billaud P, Mommerot A, Mazzucotelli JP, Kindo M. Predictors of Atrial fibrillation after coronary artery bypass grafting: a Bayesian analysis. The Annals of thoracic surgery. 2017 Jan 31;103(1):92-7.

-Frendl G, Sodickson AC, Chung MK, Waldo AL, Gersh BJ, Tisdale JE, Calkins H, Aranki S, Kaneko T, Cassivi S, Smith Jr SC. 2014 AATS Guidelines for the Prevention and Management of Peri-Operative Atrial Fibrillation and Flutter (POAF) for Thoracic Surgical Procedures. The Journal of thoracic and cardiovascular surgery. 2014 Sep;148(3):e153.

-Philip I, Berroëta C, Leblanc I. Perioperative challenges of atrial fibrillation. Current Opinion in Anesthesiology. 2014 Jun 1;27(3):344-52.

-Shen J, Lall S, Zheng V, Buckley P, Damiano RJ, Schuessler RB. The persistent problem of new-onset postoperative atrial fibrillation: a single-institution experience over two decades. The Journal of Thoracic and Cardiovascular Surgery. 2011 Feb 28;141(2):559-70.

-Villareal RP, Hariharan R, Liu BC, Kar B, Lee VV, Elayda M, Lopez JA, Rasekh A, Wilson JM, Massumi A. Postoperative atrial fibrillation and mortality after coronary artery bypass surgery. Journal of the American College of Cardiology. 2004 Mar 3;43(5):742-8.

-Kramer PA, Chacko BK, Ravi S, Johnson MS, Mitchell T, Barnes S, Arabshahi A, Dell’Italia LJ, George DJ, Steele C, George JF. Hemoglobin-associated Oxidative Stress in the Pericardial Compartment of Post-operative Cardiac Surgery Patients. Laboratory investigation; a journal of technical methods and pathology. 2015 Feb;95(2):132.

-Mathew JP, Fontes ML, Tudor IC, Ramsay J, Duke P, Mazer CD, Barash PG, Hsu PH, Mangano DT. A multicenter risk index for atrial fibrillation after cardiac surgery. Jama. 2004 Apr 14;291(14):1720-9.

-Mitchell LB, CCS Atrial Fibrillation Guidelines Committee. Canadian Cardiovascular Society atrial fibrillation guidelines 2010: prevention and treatment of atrial fibrillation following cardiac surgery. Canadian Journal of Cardiology. 2011 Feb 28;27(1):91-7.

-Chandy J, Nakai T, Lee RJ, Bellows WH, Dzankic S, Leung JM. Increases in P-wave dispersion predict postoperative atrial fibrillation after coronary artery bypass graft surgery. Anesthesia & Analgesia. 2004 Feb 1;98(2):303-10.

-Zakkar M, Ascione R, James AF, Angelini GD, Suleiman MS. Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery. Pharmacology & therapeutics. 2015 Oct 31;154:13-20.

-Qu C, Wang XW, Huang C, Qiu F, Xiang XY, Lu ZQ. High mobility group box 1 gene polymorphism is associated with the risk of postoperative atrial fibrillation after coronary artery bypass surgery. Journal of cardiothoracic surgery. 2015 Jun 25;10(1):88.

-Attaran S, Shaw M, Bond L, Pullan MD, Fabri BM. Atrial fibrillation postcardiac surgery: a common but a morbid complication☆☆☆. Interactive cardiovascular and thoracic surgery. 2011 May 1;12(5):772-7.

-Mathew JP, Parks R, Savino JS, Friedman AS, Koch C, Mangano DT, Browner WS. Atrial fibrillation following coronary artery bypass graft surgery: predictors, outcomes, and resource utilization. Jama. 1996 Jul 24;276(4):300-6.

-Blommaert D, Gonzalez M, Mucumbitsi J, Gurné O, Evrard P, Buche M, Louagie Y, Eucher P, Jamart J, Installé E, De Roy L. Effective prevention of atrial fibrillation by continuous atrial overdrive pacing after coronary artery bypass surgery. Journal of the American College of Cardiology. 2000 May 1;35(6):1411-5.

-Haghjoo M, Saravi M, Hashemi MJ, Hosseini S, Givtaj N, Ghafarinejad MH, Khamoushi AJ, Emkanjoo Z, Fazelifar AF, Alizadeh A, Sadr-Ameli MA. Optimal β-blocker for prevention of atrial fibrillation after on-pump coronary artery bypass graft surgery: carvedilol versus metoprolol. Heart Rhythm. 2007 Sep 30;4(9):1170-4.

-Almassi GH, Schowalter T, Nicolosi AC, Aggarwal A, Moritz TE, Henderson WG, Tarazi R, Shroyer AL, Sethi GK, Grover FL, Hammermeister KE. Atrial fibrillation after cardiac surgery: a major morbid event?. Annals of surgery. 1997 Oct;226(4):501.

-Ahlsson A, Bodin L, Fengsrud E, Englund A. Patients with postoperative atrial fibrillation have a doubled cardiovascular mortality. Scandinavian Cardiovascular Journal. 2009 Jan 1;43(5):330-6.

-Kaireviciute D, Aidietis A, Lip GY. Atrial fibrillation following cardiac surgery: clinical features and preventative strategies. European heart journal. 2009 Jan 27;30(4):410-25.

-Mariscalco G, Engström KG. Postoperative atrial fibrillation is associated with late mortality after coronary surgery, but not after valvular surgery. The Annals of Thoracic Surgery. 2009 Dec 31;88(6):1871-6.

-Phan K, Ha HS, Phan S, Medi C, Thomas SP, Yan TD. New-onset atrial fibrillation following coronary bypass surgery predicts long-term mortality: a systematic review and meta-analysis. European Journal of Cardio-Thoracic Surgery. 2015 Jan 18;48(6):817-24.

-El-Chami MF, Kilgo P, Thourani V, Lattouf OM, Delurgio DB, Guyton RA, Leon AR, Puskas JD. New-onset atrial fibrillation predicts long-term mortality after coronary artery bypass graft. Journal of the American College of Cardiology. 2010 Mar 30;55(13):1370-6.

-Al-Shaar L, Schwann TA, Kabour A, Habib RH. Increased late mortality after coronary artery bypass surgery complicated by isolated new-onset atrial fibrillation: A comprehensive propensity-matched analysis. The Journal of thoracic and cardiovascular surgery. 2014 Nov 30;148(5):1860-8.

-Hravnak M, Hoffman LA, Saul MI, Zullo TG, Whitman GR. Resource utilization related to atrial fibrillation after coronary artery bypass grafting. American Journal of Critical Care. 2002 May 1;11(3):228-38.

-Helgadottir S, Sigurdsson MI, Ingvarsdottir IL, Arnar DO, Gudbjartsson T. Atrial fibrillation following cardiac surgery: risk analysis and long-term survival. Journal of cardiothoracic surgery. 2012 Sep 19;7(1):87.

-Amar D, Zhang H, Leung DH, Roistacher N, Kadish AH. Older age is the strongest predictor of postoperative atrial fibrillation. The Journal of the American Society of Anesthesiologists. 2002 Feb 1;96(2):352-6.

-Nemerovski CW, Dorsch MP, Simpson RU, Bone HG, Aaronson KD, Bleske BE. Vitamin D and cardiovascular disease. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2009 Jun 1;29(6):691-708.

-Braun A, Chang D, Mahadevappa K, Gibbons FK, Liu Y, Giovannucci E, Christopher KB. Association of low serum 25-hydroxyvitamin D levels and mortality in the critically ill. Critical care medicine. 2011 Apr;39(4):671.

-Braun AB, Gibbons FK, Litonjua AA, Giovannucci E, Christopher KB. Low serum 25-hydroxyvitamin D at critical care initiation is associated with increased mortality. Critical care medicine. 2012 Jan;40(1):63.

-SCRAGG R. Seasonality of cardiovascular disease mortality and the possible protective effect of ultra-violet radiation. International Journal of Epidemiology. 1981 Dec 1;10(4):337-41.

- Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism. 2011 Jul 1;96(7):1911-30.

- Dickie LJ, Church LD, Coulthard LR, Mathews RJ, Emery P, McDermott MF. Vitamin D3 down-regulates intracellular Toll-like receptor 9 expression and Toll-like receptor 9-induced IL-6 production in human monocytes. Rheumatology. 2010 Apr 30;49(8):1466-71.

- Stach K, Kälsch AI, Nguyen XD, Elmas E, Kralev S, Lang S, Weiss C, Borggrefe M, Kälsch T. 1α, 25-Dihydroxyvitamin D3 attenuates platelet activation and the expression of VCAM-1 and MT1-MMP in human endothelial cells. Cardiology. 2011;118(2):107-15.

- Liu LC, Voors AA, Veldhuisen DJ, Veer E, Belonje AM, Szymanski MK, Silljé HH, Gilst WH, Jaarsma T, Boer RA. Vitamin D status and outcomes in heart failure patients. European journal of heart failure. 2011 Jun 1;13(6):619-25.

-Zittermann A, Kuhn J, Ernst JB, Becker T, Dreier J, Knabbe C, Gummert JF, Börgermann J. 25-hydroxyvitamin D, 1, 25-dihydroxyvitamin D and postoperative outcome in cardiac surgery. The Journal of Clinical Endocrinology & Metabolism. 2015 Jan 1;100(1):72-80.

-Hiemstra TF, Casian A, Boraks P, Jayne DR, Schoenmakers I. Plasma exchange induces vitamin D deficiency. QJM: An International Journal of Medicine. 2013 Oct 15;107(2):123-30.

-Krishnan A, Ochola J, Mundy J, Jones M, Kruger P, Duncan E, Venkatesh B. Acute fluid shifts influence the assessment of serum vitamin D status in critically ill patients. Critical Care. 2010 Nov 26;14(6):R216.

-Braun AB, Gibbons FK, Litonjua AA, Giovannucci E, Christopher KB. Low serum 25-hydroxyvitamin D at critical care initiation is associated with increased mortality. Critical care medicine. 2012 Jan;40(1):63.

-Skuladottir GV, Cohen A, Arnar DO, Hougaard DM, Torfason B, Palsson R, Indridason OS. Plasma 25-hydroxyvitamin D 2 and D 3 levels and incidence of postoperative atrial fibrillation. Journal of nutritional science. 2016 Jan;5.

-McCullough ML, Weinstein SJ, Freedman DM, Helzlsouer K, Flanders WD, Koenig K, Kolonel L, Laden F, Le Marchand L, Purdue M, Snyder K. Correlates of circulating 25-hydroxyvitamin D: cohort consortium vitamin D pooling project of rarer cancers. American journal of epidemiology. 2010 Jun 18;172(1):21-35.

-van Dam RM, Snijder MB, Dekker JM, Stehouwer CD, Bouter LM, Heine RJ, Lips PT. Potentially modifiable determinants of vitamin D status in an older population in The Netherlands.

-Chen WR, Liu ZY, Shi Y, Yin DW, Wang H, Sha Y, Chen YD. Relation of low vitamin D to nonvalvular persistent atrial fibrillation in Chinese patients. Annals of Noninvasive Electrocardiology. 2014 Mar 1;19(2):166-73.

-Demir M, Uyan U, Melek M. The effects of vitamin D deficiency on atrial fibrillation. Clinical and Applied Thrombosis/Hemostasis. 2014 Jan;20(1):98-103.

-Ozcan OU, Gurlek A, Gursoy E, Gerede DM, Erol C. Relation of vitamin D deficiency and new–onset atrial fibrillation among hypertensive patients. Journal of the American Society of Hypertension. 2015 Apr 30;9(4):307-12.

-Zittermann A, Kuhn J, Dreier J, Knabbe C, Gummert JF, Börgermann J. Vitamin D status and the risk of major adverse cardiac and cerebrovascular events in cardiac surgery. European heart journal. 2013 Jan 12;34(18):1358-64.

-Gode S, Aksu T, Demirel A, Sunbul M, Gul M, Bakır I, Yeniterzi M. Effect of vitamin D deficiency on the development of postoperative atrial fibrillation in coronary artery bypass patients. Journal of cardiovascular and thoracic research. 2016;8(4):140.

- Hyppönen E, Läärä E, Reunanen A, Järvelin MR, Virtanen SM. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. The Lancet. 2001 Nov 3;358(9292):1500-3.

-Dong JY, Zhang W, Chen JJ, Zhang ZL, Han SF, Qin LQ. Vitamin D intake and risk of type 1 diabetes: a meta-analysis of observational studies. Nutrients. 2013 Sep 12;5(9):3551-62.

-Chiu KC, Chu A, Go VL, Saad MF. Hypovitaminosis D is associated with insulin resistance and β cell dysfunction. The American journal of clinical nutrition. 2004 May 1;79(5):820-5.

-Pittas AG, Lau J, Hu FB, Dawson-Hughes B. The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. The Journal of Clinical Endocrinology & Metabolism. 2007 Jun;92(6):2017-29.

- Emren SV, Aldemir M, Ada F. Does deficiency of vitamin d increase new onset atrial fibrillation after coronary artery bypass grafting surgery?. InThe heart surgery forum 2016 Aug (Vol. 19, No. 4, pp. E180-4).

- Gode S, Aksu T, Demirel A, Sunbul M, Gul M, Bakır I, Yeniterzi M. Effect of vitamin D deficiency on the development of postoperative atrial fibrillation in coronary artery bypass patients. Journal of cardiovascular and thoracic research. 2016;8(4):140.

Files
IssueVol 13 No 4 (2018): J Teh Univ Heart Ctr QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/jthc.v13i4.639
Keywords
Atrial fibrillation Vitamin D deficiency Coronary artery bypass

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Daie M, Hajhossein Talasaz A, Karimi A, Gholami K, Salehiomran A, Ariannejad H, Jalali A. Relationship between Vitamin D Levels and the Incidence of Post Coronary Artery Bypass Graft Surgery Atrial Fibrillation. J Tehran Heart Cent. 2018;13(4):159-165.