Update on Management of Postoperative Atrial Fibrillation After Cardiac Surgery

Ronsoni, Rafael de March; Souza, Arthur Zanfrilli Marques; Leiria, Tiago Luiz Luz; Lima, Gustavo Glotz de

doi:10.21470/1678-9741-2019-0164

Cited by 8 publications

(3 citation statements)

References 46 publications

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“…Atrial fibrillation after cardiac surgery (AFACS) is the most frequent arrhythmia in the postoperative period of cardiac surgery with an incidence ranging from 10 to 65%. 1,2 This wide range in the incidence can be attributed to several factors, including the type of surgical procedure, patient demographics and history, the criteria used for diagnosis, and the methods of electrocardiographic (ECG) monitoring. 3,4 For example, AFACS is near 11% when the diagnosis is based on scheduled 12-lead ECGs, but more than 40% when continuous ECG recording or Holter monitoring is used.…”

Section: Introductionmentioning

confidence: 99%

“…5 The incidence of AFACS has been reported to range between 16 and 30% when the diagnosis is made on the basis of patient symptoms. 5,6 An expert consensus document defined the diagnosis of atrial fibrillation (AF) as requiring a 12-lead ECG or a rhythm strip of at least 30 seconds duration that demonstrates 1 irregular RR intervals in the absence of complete atrioventricular block, 2 an absence of distinct P waves on surface ECG, and 3 an atrial cycle length that is variable and generally less than 200 milliseconds. 7,8 While AFACS has been associated with stroke and other systemic embolic manifestations, renal failure, and congestive heart failure (HF), it is difficult to determine whether AFACS is directly responsible for or comorbid with these complications.…”

Section: Introductionmentioning

confidence: 99%

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Atrial Fibrillation after Rheumatic Heart Valve Surgery: Incidence, Predictors, and Outcomes

Ibrahim

Kheirallah

Mayyas

et al. 2022

Thorac Cardiovasc Surg

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Background Atrial fibrillation after cardiac surgery (AFACS) impacts 10 to 65% of patients. AFACS is associated with stroke and other systemic embolic manifestations. Methods Patients at our hospital who underwent rheumatic valve surgery procedures including aortic valve replacement (AVR), mitral valve replacement (MVR), AVR with coronary artery bypass grafting (CABG), MVR with CABG, or AVR and MVR with/without CABG were included in this study in the period from 2002 to 2017. Results In total, 346 patients were included in the current analysis, with a mean age of 51.6 ± 16.1 years, and 51% were males. AFACS was documented in 102 patients (29.9%) . Univariate predictors of AFACS included age, gender, body mass index (BMI), operation type, left ventricular ejection fraction (EF), left atrial (LA) diameter, previous history of AF, use of aldosterone antagonists more than a month before surgery, use of diuretics more than a month before surgery, length of ICU stay, total length of stay, cross-clamp time more than 90 minutes, pump time more than 120 minutes, postoperative acute kidney injury, left ventricular dimensions.By multivariate analysis, only age (p = 0.028, AOR = 10.6), male gender (p = 0.021, AOR = 3.4), type of surgery (p = 0.034, AOR = 7.12), history of AF (p = 0.018, AOR = 2.32), BMI (p < 0.001, AOR = 3.91), EF before surgery (p ≤ 0.001, AOR = 3.91), and LA diameter (p = 0.0051, AOR = 18.23) were independent predictors of AFACS. Conclusion This study identifies risk factors associated with the development of atrial fibrillation after rheumatic valve heart surgery. Older patients, male gender, type of surgery, preoperative AF, BMI, EF before surgery, and LA diameter are independent predictors of AF after cardiac valve surgery.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Atrial Fibrillation after Rheumatic Heart Valve Surgery: Incidence, Predictors, and Outcomes

Ibrahim

Kheirallah

Mayyas

et al. 2022

Thorac Cardiovasc Surg

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“…( 4 ). However, no definite strategy has been confirmed as an effective preventative method for POAF ( 5 , 6 ). Dexmedetomidine (Dex) is well-applied perioperative medication for patients that received cardiac surgery ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Influence of Dexmedetomidine on Post-operative Atrial Fibrillation After Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials

Peng

Juan

et al. 2021

Front. Cardiovasc. Med.

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Background: Previous clinical studies and meta-analysis evaluating the influence of dexmedetomidine on postoperative atrial fibrillation showed inconsistent results. We performed an updated meta-analysis to evaluate the influence of dexmedetomidine on incidence of postoperative atrial fibrillation after cardiac surgery.Methods: Randomized controlled trials that evaluated the potential influence of dexmedetomidine on the incidence of atrial fibrillation after cardiac surgery were obtained by search of PubMed, Embase, and Cochrane's Library databases from inception to April 12, 2021. A random-effects model incorporating the potential publication bias was used to pool the results. Influences of patient or study characteristics on the efficacy of dexmedetomidine on atrial fibrillation after cardiac surgery were evaluated by meta-regression and subgroup analyses.Results: Fifteen studies with 2,733 patients were included. Pooled results showed that dexmedetomidine significantly reduced the incidence of atrial fibrillation compared to control (OR: 0.72, 95% CI: 0.55–0.94, p = 0.02) with mild heterogeneity (I2 = 26%). Subgroup analysis showed that dexmedetomidine significantly reduced the incidence of atrial fibrillation in studies from Asian countries (OR: 0.41, 95% CI: 0.26–0.66, p < 0.001), but not in those from non-Asian countries (OR: 0.89, 95% CI: 0.71–1.10, p = 0.27; p for subgroup difference = 0.004). Meta-regression analysis showed that the mean age and proportion of male patients may modify the influence of dexmedetomidine on POAF (coefficient = 0.028 and 0.021, respectively, both p < 0.05). Subgroup analysis further showed that Dex was associated with reduced risk of atrial fibrillation after cardiac surgery in studies with younger patients (mean age ≤ 61 years, OR = 0.44, 95% CI: 0.28–0.69, p = 0.004) and smaller proportion of males (≤74%, OR = 0.55, 95% CI: 0.36–0.83, p = 0.005), but not in studies with older patients or larger proportion of males (p for subgroup difference = 0.02 and 0.04).Conclusions: Current evidence supports that perioperative administration of dexmedetomidine may reduce the risk of incidental atrial fibrillation after cardiac surgery, particularly in Asians.

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Surgical Coronary Revascularization in Patients With Underlying Atrial Fibrillation: State-of-the-Art Review

Dąbrowski,

Kurasz,

Pasierski

et al. 2024

Mayo Clinic Proceedings

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Update on Management of Postoperative Atrial Fibrillation After Cardiac Surgery

Cited by 8 publications

References 46 publications

Atrial Fibrillation after Rheumatic Heart Valve Surgery: Incidence, Predictors, and Outcomes

Atrial Fibrillation after Rheumatic Heart Valve Surgery: Incidence, Predictors, and Outcomes

Influence of Dexmedetomidine on Post-operative Atrial Fibrillation After Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials

Surgical Coronary Revascularization in Patients With Underlying Atrial Fibrillation: State-of-the-Art Review

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