Research Article| Volume 233, P16-31, July 2021

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Mechanism of IL-6-related spontaneous atrial fibrillation after coronary artery grafting surgery: IL-6 knockout mouse study and human observation

Published:January 16, 2021DOI:
      Clinical observation and ex vivo studies have established a strong association between inflammation and postoperative atrial fibrillation (POAF). However, it is unclear whether the inflammatory phenotype is causally linked to this event or is an epiphenomenon, and it is not known which inflammatory meditators may increase susceptibility to POAF. The limitations of available animal models of spontaneous POAF (sPOAF) makes it difficult to select an experimental system. Here, we provide experimental and clinical evidence for mechanistic involvement of interleukin-6 (IL-6) in sPOAF. PHASE I: We established a mouse model of cardiac surgery with nonpaced sPOAF. IL-6 knockout mice were protected from sPOAF compared with wild-type mice. PHASE II: At 48 hours after surgery, the heart was separated into 6 regions and cultured. IL-6 was expressed in all regions, with highest abundance in the left atrium (LA). In PHASE III, we demonstrated that IL-6 in the LA elicited early profibrotic properties in atria via the pSTAT3/STAT3 signaling pathway and contributed to sPOAF. PHASE IV: In a translational prospective clinical study, we demonstrated that humans with POAF had a higher IL-6 concentration in pericardial drainage (PD). This study provides preliminary evidence of a causal relationship between IL-6 and POAF in a novel nonpaced sPOAF mouse model. IL-6 is a crucial prerequisite for eliciting profibrotic properties in cardiac myocytes via the pSTAT3 pathway during the early postoperative period, leading to an increased susceptibility to POAF. Measuring IL-6 in PD could be a new noninvasive biomarker for the clinical prediction of POAF.


      AI (anti-inflammatory), Cx40 (connexin 40), Cx43 (connexin 43), IL-6 (interleukin-6), KO (knockout), LA (left atrium), LV (left ventricle), NAI (non–anti-inflammatory), OPCAB (off-pump coronary bypass grafting surgery), PC (pericardium), PCF (pericardial fluid), PD (pericardial drainage), POAF (postoperative atrial fibrillation), PV (pulmonary vein), RA (right atrium), RV (right ventricle), sPOAF (spontaneous postoperative atrial fibrillation), ssPOAF (sustained spontaneous postoperative atrial fibrillation), STAT3 (signal transducer and activator of transcription 3), WT (wild type)
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