Ralph Damiano, Jr., M.D.Researcher Seeks Prevention of Post-Surgical Complication
Atrial fibrillation -- a rapid, irregular twitching of the upper chambers of the heart -- occurs in about one-third of patients who undergo heart surgeries such as coronary bypass or valve replacement. The condition can lead to serious post-operative complications, including congestive heart failure or stroke.
Cardiac researchers at Washington University School of Medicine in St. Louis have found that treatment with anti-inflammatory drugs after heart surgery may lessen or prevent atrial fibrillation.
"Patients have suffered postoperative atrial fibrillation since the early days of cardiac surgery, and while beta-blockers -- drugs used to prevent abnormal heart rhythms -- seem to reduce the incidence, there has been no cure," said Ralph Damiano, Jr., M.D., the John Schoenberg Professor of Surgery and a cardiovascular specialist at Barnes-Jewish Hospital. "Our research suggests inflammation is the cause of postoperative atrial fibrillation, and this gives us new options for preventative therapy."
The researchers found that the severity of atrial fibrillation corresponds to the amount of inflammation in surgically treated heart tissue. The inflammatory response is a normal response of tissue to injury that speeds the healing process in most instances. But in this case, inflammation can lead to changes in the electrical properties of the atria, causing irregular heartbeats.
"We found that inflammation led to non-uniform conduction of electrical impulses in the atria," Damiano said. "There were areas of very slow conduction and areas of normal conduction. The result was chaotic contractions of the atria."
Anti-inflammatory therapy increased the uniformity of the conduction of electrical impulses and decreased the incidence of atrial fibrillation.
Dr. Damiano began his study of complications of cardiac surgery with a 1993 AHA Beginning Grant-in-Aid award he received while working at Virginia Commonwealth University. “My AHA grant was seminal to the start of my research career,” he said.
Next, the researchers will conduct laboratory tests to block inflammation of the heart tissue while preserving the normal inflammatory response in the rest of the body. "Our hope is that we can soon bring this treatment to the operating room and eliminate one of the major complications of heart surgery," Damiano said.
Washington University School of Medicine's full-time and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked third in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.