The Role of High-Normal Potassium Levels in the Maintenance of Sinus Rhythm Following Cardiac Surgery in Patients with Persistent Atrial Fibrillation

Kiran Kishor  Pisekar; Ritesh  Shah; Kaushal  Patel; Ramesh  Patel; Bhawana  Sharma; Cheshta  Sangwan; Pratik  Shah

doi:10.18502/jthc.v21i2.21692

Kiran Kishor Pisekar Department of Cardiac Anesthesia, UN Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
Ritesh Shah Department of Cardiac Anesthesia, UN Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
Kaushal Patel Department of Cardiac Anesthesia, UN Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
Ramesh Patel Department of Cardiac Anesthesia, UN Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
Bhawana Sharma Department of Cardiac Anesthesia, UN Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
Cheshta Sangwan Department of Cardiac Anesthesia, UN Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
Pratik Shah Department of Research, UN Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India.

DOI: https://doi.org/10.18502/jthc.v21i2.21692

Keywords: Atrial Fibrillation; Potassium; Rhythm; Cardiopulmonary Bypass

Abstract

Atrial fibrillation (AF) is highly prevalent in patients undergoing cardiac surgery, and persistent AF poses significant challenges in postoperative rhythm management. This study investigated whether maintaining high-normal potassium levels (>4.4 mmol/L) during and after cardiopulmonary bypass (CPB) enhances SR restoration and stability in patients with persistent AF. A prospective observational study of 245 patients undergoing elective cardiac surgery was conducted, with potassium levels maintained above 4.5 mmol/L during CPB and supplemented postoperatively for 48 hours. Outcomes included SR conversion rates, hemodynamic parameters, and predictors of rhythm stability. Results showed that 87% of patients reverted to SR post-CPB, with 71% maintaining SR at 48 hours. Higher intraoperative potassium levels (mean, 4.54 vs 4.41 mmol/L; P=.02) significantly predicted successful cardioversion, whereas larger left atrial diameter (67.2 vs 53.8 mm; P<.001) correlated with AF persistence. Hemodynamic stability improved in patients with SR, with lower heart rates, higher mean arterial pressures, and reduced ICU stays (52.5 vs 58.8 h; P<.001). The study concludes that maintaining high-normal potassium levels during and after CPB facilitates SR restoration and short-term stability in patients with persistent AF, improving hemodynamics and reducing ICU dependency. Left atrial enlargement remains a key determinant of AF recurrence. These findings support perioperative potassium optimization as a feasible strategy to enhance postoperative outcomes, warranting further multicenter trials for validation