<p>Predictors of Postoperative Atrial Fibrillation After Abdominal Surgery and Insights from Other Surgery Types</p>

Abstract

Postoperative atrial fibrillation (POAF) in relation to abdominal surgery can cause clinical deterioration, prolonged hospitalization, admittance to intensive care units, stroke and increased mortality. The current review focus on patients developing POAF in relation to abdominal surgery and aims to present the current knowledge on predictors of this condition. Furthermore, predictors identified in other surgical populations that may be transferable and guide future research within the field of abdominal surgery will be presented. A systematic literature search of patients undergoing abdominal surgery and developing POAF was performed on PubMed and Embase. All types of study interventions, comparators and designs were included. All studies included reported POAF as primary or secondary outcome. All peer-reviewed English full-text manuscripts regardless of publication date were included. We included five studies out of the 149 unique records identified. Age, congestive heart failure, hypertension, vascular disease and surgical approach are risk factors associated with the development of POAF. Furthermore, inflammation biomarkers, dobutamine stress echocardiography and cardiac single-photon emission computed tomography can predict POAF. Insights from other surgical cohorts reveal that other biomarkers (ie, brain natriuretic peptide (BNP) and N-terminal pro-BNP), electrocardiography and echocardiography can be used to predict POAF and may be applied in future research projects within the field of abdominal surgery. In conclusion, very scarce evidence is currently available in predicting POAF after abdominal surgery. However, predicting POAF seems possible and feasible, why the authors encourage readers to initiate new research to close the current knowledge gap and improve clinical management.

Frequency and risk factors of atrial fibrillation after acute abdominal surgery: A prospective cohort study

“…These influences might create an atrial substrate that is more prone to produce AF in acute illness and a setting with surgical stressors. 23,24 We observed a trend for higher occurrences in several subgroups, such as those patients undergoing the most urgent and invasive surgery. These findings add to the concept that the physiological stress of undergoing acute illness and surgery could immensely impact the hemodynamics, catecholamine levels, oxidative stress, and inflammatory processes that trigger POAF.…”

“…It has been theorized that the demographic and comorbidity risk factors affect the atrial myocardium, resulting in inflammation, dilatation, and fibrosis. These influences might create an atrial substrate that is more prone to produce AF in acute illness and a setting with surgical stressors 23,24 …”

“…Patients who develop POAF after abdominal surgery probably have more comorbidities and are inherently at a higher risk of complications 12,13 . Concomitant conditions, for example, fever, anemia, hypotension, hypoxia, and surgical stress, act as triggers inducing AF in patients with a susceptible myocardium 24–29 . In turn, AF may influence the patients' hemodynamics and oxygenation, leading to further destabilization and increased risk of death.…”

“…12,13 Concomitant conditions, for example, fever, anemia, hypotension, hypoxia, and surgical stress, act as triggers inducing AF in patients with a susceptible myocardium. [24][25][26][27][28][29] In turn, AF may influence the patients' hemodynamics and oxygenation, leading to further destabilization and increased risk of death.…”