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(Circulation. 2004;110:2588-2590.)
© 2004 American Heart Association, Inc.

Arrhythmia/Electrophysiology

Association of Anti–Heat Shock Protein 65 Antibodies With Development of Postoperative Atrial Fibrillation

Kaushik Mandal, MS, MRCS; Marjan Jahangiri, FRCS; Michael Mukhin, MRCS; Jan Poloniecki, PhD; A. John Camm, MD; Qingbo Xu, MD, PhD

From the Departments of Cardiothoracic Surgery (K.M., M.J.) and Cardiac and Vascular Sciences (M.M., J.P., A.J.C., Q.X.), St George’s Hospital & Medical School, London, UK.

Correspondence to Professor Qingbo Xu, Department of Cardiac and Vascular Sciences, St. George’s Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK. E-mail q.xu{at}sghms.ac.uk

Received February 23, 2004; de novo received April 13, 2004; revision received June 4, 2004; accepted June 4, 2004.

Background— Atrial fibrillation (AF) is a frequently encountered arrhythmia after cardiac surgery, but its underlying mechanisms are still unclear. We hypothesize that autoimmune and inflammatory responses against heat shock protein 65 (HSP65) may be involved and hence examined the relationship between HSP65 autoantibodies and occurrence of postoperative AF.

Methods and Results— A prospective study of 329 patients undergoing elective primary CABG was undertaken. Cardiovascular risk factors, ECG characteristics, medications, and intraoperative and postoperative features were documented. Anti-HSP65 antibodies and C-reactive protein levels were measured in all preoperative blood samples with ELISA. Postoperative AF was defined as the characteristic arrhythmia, lasting for at least 15 minutes and confirmed on 12-lead ECG and occurring within the first postoperative week. This occurred in 62 patients (19%). In univariate analysis, HSP65 antibodies were significantly higher in patients with postoperative AF (P=0.02). History of previous myocardial infarction, duration of bypass, number of distal anastomosis, and duration of ventilation were also associated with AF (P<0.05), but C-reactive protein levels were not (P=0.13). Multivariate analysis confirmed the positive association of HSP65 antibodies with postoperative AF (OR, 1.41; P=0.04) independent of age, sex, other cardiovascular risk factors, severity of coronary artery disease, duration of ventilation, duration of bypass, and left ventricular function.

Conclusions— We report a novel association between anti-HSP65 antibodies and occurrence of postoperative AF, indicating a possible role for antibody-mediated immune response in its pathogenesis.

Key Words: antibodies • cardiopulmonary bypass • fibrillation • immunity

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