Effect of Clinical and Genetic Factors on the Development of Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting (CABG) in Egyptian Patients Receiving Beta-Blockers

• Published in: Cardiovascular drugs and therapy 2024-02, Vol.38 (1), p.99-108
• Main Authors: El Gindy, Dina M. K., Solayman, Mohamed H., Khorshid, Ramy, Schaalan, Mona F., El Wakeel, Lamia M.
• Format: Article
• Language: English
• Subjects: Adrenergic receptors; Alleles; Atrial Fibrillation - diagnosis; Atrial Fibrillation - drug therapy; Atrial Fibrillation - epidemiology; Beta blockers; Bypass; Cardiac arrhythmia; Cardiology; Coronary artery; Coronary Artery Bypass - adverse effects; Coronary vessels; Disease prevention; Egypt; Fibrillation; G protein-coupled receptor kinase; Genetic factors; Genotyping; Grafting; Heart surgery; Humans; Hypertension; Kinases; Mathematical analysis; Medicine; Medicine & Public Health; Multivariate analysis; Original; Original Article; Polymorphism, Single Nucleotide; Prophylaxis; Receptors (physiology); Retrospective Studies; Risk Factors; Single-nucleotide polymorphism
• ISSN: 0920-3206; 1573-7241
• DOI: 10.1007/s10557-022-07380-6

Purpose Prophylactic beta-blockers are recommended to prevent postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG). Polymorphisms in the beta-1 adrenergic receptor (ADRB1) and G protein-coupled receptor kinase 5 (GRK5) genes are associated with variable responses to beta-blockers. The aim of this study was to determine the clinical and genetic factors that influence the response to beta-blockers for POAF prophylaxis after CABG. Methods Patients undergoing isolated CABG and receiving prophylactic beta-blockers ( n  = 249) were prospectively recruited and followed up for 6 postoperative days. Genotyping of ADRB1 rs1801253, and 3 GRK5 SNPs (rs3740563, rs10787959, and rs17098707) was performed. Results Of the 249 patients, 52 patients (20.8%) experienced POAF. Age, hypertension, vasopressor use, calculated POAF risk score, GRK5 rs2230345 T-allele, and GRK5 rs3740563 A-allele were associated with POAF despite beta-blocker prophylaxis. The multivariate analysis revealed that age [odds ratio (OR) 1.06, 95% CI 1.02–1.11, p  = 0.003] and GRK5 rs2230345 T-allele [OR 2.81, 95% CI 1.39–5.67, p  = 0.004] were independent predictors of POAF after CABG despite beta-blocker prophylaxis. Conclusion GRK5 rs2230345 T-allele carriers were less responsive than AA genotype carriers to prophylactic beta-blockers for the prevention of POAF after CABG. The study was registered on http://clinicaltrials.gov in March 2019, with trial registration number (TRN): NCT03871647.