Mirhosseini Seyed Jalil, Ali-Hassan-Sayegh Sadegh, Forouzannia Seyed Khalil
Department of Cardiovascular Surgery, Yazd Cardiovascular Researches Center, Afshar Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Saudi J Anaesth. 2013 Jan;7(1):40-2. doi: 10.4103/1658-354X.109807.
Atrial fibrillation (AF) occurs in 30% patients on the second or third day post operation; therefore, it is the most prevalent and complicated arrhythmia after open heart surgery. White blood cell (WBC) count seems to be most significantly associated with cardiovascular disorders. This study was designed to evaluate the exact relationship between preoperative WBC count and post-Coronary artery bypass graft (CABG) AF in patients with severe left ventricle (LV) dysfunction who underwent elective off-pump coronary artery bypass.
This study was conducted on 104 patients from among 400 patients with severe LV dysfunction undergoing elective off-pump CABG surgery from February 2011 to February 2012, in Afshar Cardiovascular Center, Yazd, Iran. Patients with emergency surgery, unstable angina creatinine higher than 2.0 mg/dL, malignancy, or immunosuppressive disease were excluded. Preoperative serological tests of the participants, such as WBC counts, were saved in their medical dossiers. Of the 400 patients undergoing CABG, AF was found in 54 cases; these 54 male patients formed the experimental group and 60 other patients in the intensive care unit (ICU) and hospital stay without postoperative AF were part of the control group.
The average age of the patients was 68.5±12.8 years. WBC counts in patients with and without AF three days before surgery were 12,340±155 and 8,950±170, respectively. On surgical day, WBC counts in the patients with and without AF were 13,188±140 and 9,145±255, respectively (P value three days before surgery: 0.04; P value on surgical day: 0.01). Of the 54 male patients with postoperative AF (POAF), duration of AF was more in cases with elevated WBC count (12,000-14,000) than in those with lower elevated WBC count (10,000-12,000) (]P=0.025), but there was no relationship between frequency of recurrence of AF and grading of elevation of WBC count (]P=0.81).
These findings show that three days before surgery and on surgery day, there was a difference in WBC count between both groups. So, preoperative WBC count may predict the incidence and duration of AF; however, it cannot be a predictor of the frequency of recurrence of AF. Finally, WBC count is an independent marker for POAF and duration of AF.
心房颤动（AF）发生于30%的患者术后第二天或第三天；因此，它是心脏直视手术后最常见且复杂的心律失常。白细胞（WBC）计数似乎与心血管疾病关联最为显著。本研究旨在评估择期非体外循环冠状动脉旁路移植术（CABG）的严重左心室（LV）功能不全患者术前WBC计数与冠状动脉旁路移植术后房颤之间的确切关系。
本研究于2011年2月至2012年2月在伊朗亚兹德的阿夫沙尔心血管中心对400例接受择期非体外循环CABG手术的严重LV功能不全患者中的104例进行。排除急诊手术、不稳定型心绞痛、肌酐高于2.0mg/dL、恶性肿瘤或免疫抑制疾病患者。参与者的术前血清学检查，如WBC计数，保存在他们的病历中。在400例接受CABG的患者中，发现54例发生房颤；这54例男性患者组成实验组，重症监护病房（ICU）中另外60例术后未发生房颤的患者及住院患者为对照组。
患者的平均年龄为68.5±12.8岁。术前三天有房颤和无房颤患者的WBC计数分别为12340±155和8950±170。手术当天，有房颤和无房颤患者的WBC计数分别为13188±140和9145±255（术前三天P值：0.04；手术当天P值：0.01）。在54例术后房颤（POAF）男性患者中，WBC计数升高（12000 - 14000）的患者房颤持续时间比WBC计数升高较低（10000 - 12000）的患者更长（P = 0.025），但房颤复发频率与WBC计数升高分级之间无关系（P = 0.81）。
这些发现表明，术前三天和手术当天，两组之间WBC计数存在差异。所以，术前WBC计数可能预测房颤的发生率和持续时间；然而，它不能作为房颤复发频率的预测指标。最后，WBC计数是POAF及房颤持续时间的独立标志物。
