Prevention of atrial fibrillation following cardiac surgery: Basis for a novel therapeutic strategy based on non-hypoxic myocardial preconditioningReportar como inadecuado




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Resumen

Atrial fibrillation is the most common complication of cardiac surgical procedures performed with cardiopulmonary bypass. It contributes toincreased hospital length of stay and treatment costs. At present, preventive strategies offer only suboptimal benefits, despite improvements inanesthesia, surgical technique, and medical therapy. The pathogenesis of postoperative atrial fibrillation is considered to be multifactorial.However oxidative stress is a major contributory factor representing the unavoidable consequences of ischemia-reperfusion cycle occurring in thissetting. Considerable evidence suggests the involvement of reactive oxygen species ROS in the pathogenic mechanism of this arrhythmia.Interestingly, the deleterious consequences of high ROS exposure, such as inflammation, cell death apoptosis-necrosis or fibrosis, may beabrogated by a myocardial preconditioning process caused by previous exposure to moderate ROS concentration known to trigger survivalresponse mechanisms. The latter condition may be created by n-3 PUFA supplementation that could give rise to an adaptive responsecharacterized by increased expression of myocardial antioxidant enzymes and-or anti-apoptotic pathways. In addition, a further reinforcement ofmyocardial antioxidant defenses could be obtained through vitamins C and E supplementation, an intervention also known to diminish enzymaticROS production. Based on this paradigm, this review presents clinical and experimental evidence supporting the pathophysiological andmolecular basis for a novel therapeutic approach aimed to diminish the incidence of postoperative atrial fibrillation through a non-hypoxicpreconditioning plus a reinforcement of the antioxidant defense system in the myocardial tissue.



Autor: Rodrigo Salinas, Ramón; - Castillo Koch, Rodrigo; - Cereceda, Mauricio; - Castillo, Rodrigo; - Asenjo, René; - Zamorano, Jaime;

Fuente: http://repositorio.uchile.cl/



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