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Yosuke Ishii, MD, PhD, Richard B. Schuessler, PhD, Sydney L

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1 Postoperative atrial fibrillation: The role of the inflammatory response 
Yosuke Ishii, MD, PhD, Richard B. Schuessler, PhD, Sydney L. Gaynor, MD, Kiyomi Hames, MD, Ralph J. Damiano, MD  The Journal of Thoracic and Cardiovascular Surgery  Volume 153, Issue 6, Pages (June 2017) DOI: /j.jtcvs Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

2 Figure 1 The right atriotomy during the initial surgery (A) and 3 days after the initial surgery (B). SVC, Superior vena cava; RAA, right atrial appendage; RT PVs, right pulmonary veins; IVC, inferior vena cava. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

3 Figure 2 Atrial electrograms (A) and activation maps (B) are shown at 4 separate points in time during postoperative atrial fibrillation in the atriotomy group. The maps represent the time since the last activation, with red being the leading edge of the wavefront. The atrial activation rotates around the right atriotomy during the induced postoperative atrial fibrillation (black arrows). The maps represent the lateral right atrium. The black line represents the incision on the lateral right atrium. The location of the selected electrograms corresponds to the activation time at the 4 sites shown in (A). The time since the last activation at each time point is shown with color coding at 15-ms increments. ECG, Electrocardiogram; SVC, superior vena cava; RAA, right atrial appendage; PVs, pulmonary veins IVC, inferior vena cava; AV groove, atrioventricular groove. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

4 Figure 3 Activation maps from selected regions of the right atrium (RA) and left atrium (LA) during atrial pacing. Typical examples of activation maps are shown from each group. Note that the inhomogeneity of the conduction increased from the anesthesia group to the atriotomy group in the RA. The steroid group normalized to the control levels. The LA activations in the anesthesia, atriotomy, and steroid groups are homogeneous. The rectangle indicates the pacing site. The vertical line in the center of the panel in the atriotomy and steroid groups indicates the atrial incision line. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

5 Figure 4 A, Inhomogeneity indices of the right atrium (RA) and left atrium (LA) conduction. B, Myeloperoxidase activity of the RA and LA myocardium. OD, Optical density. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

6 Figure 5 Relationship between the inhomogeneity of the atrial conduction and myeloperoxidase (MPO) activity. The inhomogeneity of the atrial conduction is associated with a proportional increase in the MPO activity (r = 0.51, P = .03). The line indicates the approximate line of data. OD, Optical density. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

7 Atrial activation rotates around the right atriotomy during postoperative AF.
The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

8 Video 1 Atrial activation rotates around the right atriotomy during postoperative atrial fibrillation in a clockwise fashion in the atriotomy group. The maps represent the time since the last activation, with red being the leading edge of the wavefront. The atrial activation rotates around the right atriotomy during induced postoperative atrial fibrillation. The maps represent the lateral right atrium. The black line represents the incision on the lateral right atrium. The time since the last activation at each time point is shown with color coding at 15-ms increments. SVC, Superior vena cava; RAA, right atrial appendage; PVs, pulmonary veins; IVC, inferior vena cava. Video available at: The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

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