Mechanisms, Prevention, and Treatment of Atrial Fibrillation After Cardiac Surgery: A Narrative Review

Boons, Jeroen; Biesen, Stefaan Van; Fivez, Tom; Velde, Marc Van de; Tmimi, Layth Al

doi:10.1053/j.jvca.2020.11.030

Cited by 24 publications

(19 citation statements)

References 55 publications

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“…Moreover, a study by Musa et al [45] of 637 patients undergoing CABG procedures found that taking beta blockers significantly reduced the risk of having POAF (adjusted OR: 1.611, 95% CI: 1.049-2.467, p = 0.029). However, it appears that to sustain its prophylactic effect it must be continued postoperatively as the immediate withdrawal of beta blockers may lead to a 91% increased chance in developing POAF [36]. Additionally, in the aforementioned study by Mohamed F. Ismail et al [63], it was suggested that the delayed postoperative beta blocker therapy post CABG surgery contributed to the development of POAF in the cohort.…”

Section: Beta Blockersmentioning

confidence: 99%

“…Caucasian ethnicity has been found to be a predictor for POAF [5,7,36,37]. A study by Efird et al [37] of 13,594 patients undergoing first-time, isolated CABG found that POAF is significantly associated with white race (95% CI, p < 0.0001).…”

Section: Ethnicitymentioning

confidence: 99%

“…Current guidelines may dictate intraoperative and postoperative magnesium and potassium supplementation, yet both of these electrolytes been linked to POAF [5,36,45].…”

Section: Electrolytesmentioning

confidence: 99%

“…However, Jason W Greenberg et al [5] signposted that high levels of magnesium may also contribute towards POAF, despite the apparent anti arrhythmic properties of magnesium. This may be clarified by Jeroen Boons et al [36], who states that the association between hypomagnesemia and POAF has been widely studied and accepted, but rather it's the use of magnesium supplementation as prophylaxis that is doubted, and this was later clarified by a meta-analysis that it did not prevent POAF.…”

Section: Electrolytesmentioning

confidence: 99%

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Determinants of atrial fibrillation after cardiac surgery

Qureshi¹,

Ahmed²,

Massie³

et al. 2021

Reviews in Cardiovascular Medicine

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Post-operative Atrial fibrillation (POAF) is a common complication post cardiac surgery. It can result in detrimental short-and long-term outcomes due to the increased risk of stroke, cardiac arrest and congestive heart failure in addition to prolonged intensive care and total hospital stay raising the overall healthcare cost. Accurately identifying predictors and biomarkers for POAF ensures that patients at greatest risk can be given the appropriate prophylactic measures; resources can be distributed to the groups who are most in need and where they will gain the optimum effect. Commonly recurring predictors can be investigated further to unveil the pathophysiology behind POAF, which has yet to be fully understood. This literature review aims to examine relevant studies on the proposed predictors of POAF: increased age, gender, history of atrial fibrillation, hypertension, cardiopulmonary bypass time and the use of beta blockers amongst others. This paper will discuss the significance of both the well-known and newfound risk factors to consolidate the areas that require further exploration in order to highlight those at risk and to unravel the mechanism behind POAF.

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Section: Beta Blockersmentioning

confidence: 99%

Section: Ethnicitymentioning

confidence: 99%

“…Current guidelines may dictate intraoperative and postoperative magnesium and potassium supplementation, yet both of these electrolytes been linked to POAF [5,36,45].…”

Section: Electrolytesmentioning

confidence: 99%

Section: Electrolytesmentioning

confidence: 99%

See 2 more Smart Citations

Determinants of atrial fibrillation after cardiac surgery

Qureshi¹,

Ahmed²,

Massie³

et al. 2021

Reviews in Cardiovascular Medicine

View full text Add to dashboard Cite

show abstract

“…The development of postoperative AF has, regardless the use of a cardiopulmonary bypass, been associated with an increase of preoperative and postoperative inflammatory markers [3,25]. Inflammation is therefore suggested as an important factor in the multifactorial pathophysiological mechanisms that cause postoperative AF [26]. On the other hand, the anti-inflammatory effects of exercise, healthy food, and psychological stress PLOS ONE reduction (offered to the PRE-group) are well stated [27][28][29].…”

Section: Discussionmentioning

confidence: 99%

Prehabilitation to prevent complications after cardiac surgery - A retrospective study with propensity score analysis

et al. 2021

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Background The rising prevalence of modifiable lifestyle-related risk factors (e.g. overweight and physical inactivity) suggests the need for effective and safe preoperative interventions to improve outcomes after cardiac surgery. This retrospective study explored potential short-term postoperative benefits and unintended consequences of a multidisciplinary prehabilitation program regarding in-hospital complications. Methods Data on patients who underwent elective cardiac surgery between January 2014 and April 2017 were analyzed retrospectively. Pearson’s chi-squared tests were used to compare patients who followed prehabilitation (three times per week, at a minimum of three weeks) during the waiting period with patients who received no prehabilitation. Sensitivity analyses were performed using propensity-score matching, in which the propensity score was based on the baseline variables that affected the outcomes. Results Of 1201 patients referred for elective cardiac surgery, 880 patients met the inclusion criteria, of whom 91 followed prehabilitation (53.8% ≥ 65 years, 78.0% male, median Euroscore II 1.3, IQR, 0.9–2.7) and 789 received no prehabilitation (60.7% ≥ 65 years, 69.6% male, median Euroscore II 1.6, IQR, 1.0–2.8). The incidence of atrial fibrillation (AF) was significantly lower in the prehabilitation group compared to the unmatched and matched standard care group (resp. 14.3% vs. 23.8%, P = 0.040 and 14.3% vs. 25.3%, P = 0.030). For the other complications, no between-group differences were found. Conclusions Prehabilitation might be beneficial to prevent postoperative AF. Patients participated safely in prehabilitation and were not at higher risk for postoperative complications. However, well-powered randomized controlled trials are needed to confirm and deepen these results.

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Principles of Postoperative Care

Franko,

Shelton

2024

Contemporary Surgical Clerkships

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Mechanisms, Prevention, and Treatment of Atrial Fibrillation After Cardiac Surgery: A Narrative Review

Cited by 24 publications

References 55 publications

Determinants of atrial fibrillation after cardiac surgery

Determinants of atrial fibrillation after cardiac surgery

Prehabilitation to prevent complications after cardiac surgery - A retrospective study with propensity score analysis

Principles of Postoperative Care

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