Letter Regarding Article by Mandal et al, “Association of Anti–Heat Shock Protein 65 Antibodies With Development of Postoperative Atrial Fibrillation”

To the Editor:Mandal and colleagues 1 report a novel association between anti-heat shock protein (HSP) 65 antibodies and the occurrence of postoperative atrial fibrillation (AF), indicating a possible role for antibody-mediated immune response in its pathogenesis.The authors report significant associations between postoperative AF and anti-HSP65 antibodies, a history of previous myocardial infarction, duration of cardiopulmonary bypass, number of distal anastomoses, and duration of ventilation by univariate analysis.In addition, lower levels of anti-HSP65 antibodies and grafting the left anterior descending artery seemed to be independently associated with a decreased occurrence of postoperative AF by multivariate analysis.The present study did not, however, find an association between age, preoperative and postoperative use of ␤-adrenergic blockers, and postoperative AF.Increasing age has been a consistent independent predictor for AF after cardiac surgical procedures in most previous trials and meta-analyses.2-5 In addition, previous studies and reviews 2 consistently found that preoperative ␤-blocking agents protect against postoperative AF.Because the present study is in contrast with previous data on the association between age, preoperative ␤-blockade, and postoperative AF, the study population may not reflect a representative sample of patients undergoing coronary artery bypass surgery, which might limit possible clinical implications of the present findings.