Incidence and complications of perioperative atrial fibrillation after non-cardiac surgery for malignancy

Abstract

Background Perioperative atrial fibrillation (POAF) is one of the common arrhythmias in the setting of non-cardiac surgeries for malignancy. As POAF may cause subsequent adverse events, it is important to confirm its characteristics and risk factors. Materials and methods The pr osp e ctive cohort stu d y of surve i llan c e for periopera t ive a trial f ibrillation recurrence (PREDICT AF RECURRENCE) is an ongoing prospective, single-center, observational study that aims to illustrate the clinical impact of POAF in major non-cardiac surgery for malignancy. Patients who planned to undergo non-cardiac surgery for definitive/suspected malignancy were registered. Those with a history of AF and atrial flutter were excluded. Any 30-day complications included acute myocardial infarction, congestive heart failure, bleeding, thrombosis, any infection, and acute kidney injury. The primary endpoint was an incidence of POAF. Results The present study included 799 patients (age, 68 ± 11; male, 62%). Of these, 80 patients (10.0%) developed POAF. Notably, 66 patients (83%) had no symptoms. Any 30-day complications occurred in 180 patients (23%) (with POAF: 34 (43%); without POAF: 146 (20%); p < 0.001). POAF in 17 patients (50%) was preceded by the development of complications. No patient developed cardiogenic shock and/or acute heart failure. The association between 30-day complications and POAF development were analyzed using the multivariate adjusted model (odds ratio: 2.84; 95% confidence interval: 1.74–4.62; p < 0.001). Conclusion Ten percent of patients who underwent non-cardiac surgery for malignancy developed POAF, which was strongly associated with perioperative complications. As a majority were asymptomatic, careful observation using electrocardiography monitoring is important to avoid oversights. Clinical trial registration UMIN ID: UMIN000016146

Association of New-Onset Atrial Fibrillation After Noncardiac Surgery With Subsequent Stroke and Transient Ischemic Attack

“…AF can precede or follow the development of other cardiac and noncardiac complications after noncardiac surgery in high-risk patients, such as those undergoing surgery for malignancy. 22…”

The effect of atrial fibrillation on perioperative outcomes in patients with pancreatic cancer undergoing open pancreaticoduodenectomy: analysis of the National Inpatient Sample

“…It has been reported that AF is associated with significantly higher occurrence of perioperative complications in various surgical operations, including urinary system surgery, liver transplantation, etc. (6,7,25).…”

Self-monitoring for recurrence of secondary atrial fibrillation following non-cardiac surgery or acute illness: A pilot study

“…ECG monitoring for 48–72 h is guideline recommended for detection of postoperative AF after thoracic surgery [24] . However, surveillance for AF is not routine after non-cardiothoracic surgery, nor during many acute medical illnesses, and thus considerable numbers of transient secondary AF episodes will go undetected, particularly when a high proportion are asymptomatic or subclinical [25] , [26] . Further work is required to clarify the true incidence of secondary AF, and if necessary, develop strategies to better detect these during hospitalisation.…”