New Onset Postoperative Atrial Fibrillation is Associated with a Long-Term Risk for Stroke and Death Following Cardiac Surgery

Horwich, Peter; Buth, Karen J.; Légaré, Jean‐François

doi:10.1111/jocs.12033

Cited by 88 publications

(66 citation statements)

References 16 publications

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“…10 However, little is known about the long-term risk of ischemic stroke in patients with perioperative AF. A few single- or dual-center studies have reported an increased long-term risk of stroke in patients with perioperative AF after cardiac surgery, 11–13 whereas other single-center analyses have found no such association in this population. 14,15 Moreover, data are scarce in regard to the long-term risk of stroke from perioperative AF in patients undergoing other types of surgery.…”

mentioning

confidence: 79%

Perioperative Atrial Fibrillation and the Long-term Risk of Ischemic Stroke

Gialdini

Nearing

Bhave

et al. 2014

JAMA

284

236

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IMPORTANCE Clinically apparent atrial fibrillation increases the risk of ischemic stroke. In contrast, perioperative atrial fibrillation may be viewed as a transient response to physiological stress, and the long-term risk of stroke after perioperative atrial fibrillation is unclear. OBJECTIVE To examine the association between perioperative atrial fibrillation and the long-term risk of stroke. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study using administrative claims data on patients hospitalized for surgery (as defined by surgical diagnosis related group codes), and discharged alive and free of documented cerebrovascular disease or preexisting atrial fibrillation from nonfederal California acute care hospitals between 2007 and 2011. Patients undergoing cardiac vs other types of surgery were analyzed separately. MAIN OUTCOMES AND MEASURES Previously validated diagnosis codes were used to identify ischemic strokes after discharge from the index hospitalization for surgery. The primary predictor variable was atrial fibrillation newly diagnosed during the index hospitalization, as defined by previously validated present-on-admission codes. Patients were censored at postdischarge emergency department encounters or hospitalizations with a recorded diagnosis of atrial fibrillation. RESULTS Of 1 729 360 eligible patients, 24 711 (1.43%; 95% CI, 1.41%–1.45%) had new-onset perioperative atrial fibrillation during the index hospitalization and 13 952 (0.81%; 95% CI, 0.79%–0.82%) experienced a stroke after discharge. In a Cox proportional hazards analysis accounting for potential confounders, perioperative atrial fibrillation was associated with subsequent stroke both after noncardiac and cardiac surgery. Type of SurgeryCumulative Rate of Stroke 1 Year AfterHospitalization, % (95% CI)Hazard Ratio (95% CI)PerioperativeAtrial FibrillationNo PerioperativeAtrial FibrillationNoncardiac1.47 (1.24–1.75)0.36 (0.35–0.37)2.0 (1.7–2.3)Cardiac0.99 (0.81–1.20)0.83 (0.76–0.91)1.3 (1.1–1.6) The association with stroke was significantly stronger for perioperative atrial fibrillation after noncardiac vs cardiac surgery (P < .001 for interaction). CONCLUSIONS AND RELEVANCE Among patients hospitalized for surgery, perioperative atrial fibrillation was associated with an increased long-term risk of ischemic stroke, especially following noncardiac surgery.

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mentioning

confidence: 79%

Perioperative Atrial Fibrillation and the Long-term Risk of Ischemic Stroke

Gialdini

Nearing

Bhave

et al. 2014

JAMA

284

236

View full text Add to dashboard Cite

show abstract

“…2 POAF is associated with increased morbidity in the immediate postoperative period such as stroke, intra-aortic balloon pump use, infections, respiratory failure, renal failure and prolonged length of hospital stay. 3,4 Long-term survival analyses have demonstrated an increased mortality in CABG 5,6 and aortic valve replacement 7 patients who developed POAF. 8 In a study involving 16,169 CABG patients registered in the Society of Thoracic Surgeons Adult Cardiac Surgery Database, a 25% mortality increase was found in patients who had POAF versus those who did not, after a mean follow-up period of six years.…”

Section: Introductionmentioning

confidence: 99%

Predicting New-Onset Postoperative Atrial Fibrillation in Cardiac Surgery Patients

Tran

Perry

Dupuis

et al. 2015

Journal of Cardiothoracic and Vascular Anesthesia

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“…The negative effect of long term AF has been extensively studied in the previous research [2,16,17]. The incidence of AF in postcardiotomy patients may also depend on the type of surgery.…”

Section: Discussionmentioning

confidence: 99%

A novel treatment strategy of new onset atrial fibrillation after cardiac surgery: an observational prospective study

Zeriouh

Sabashnikov

Choi

et al. 2014

J Cardiothorac Surg

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ObjectiveThe aim of this prospective observational study was to evaluate the efficiency of a new escalating treatment strategy with vernakalant, flecainide and electrical cardioversion (EC) in patients with new onset atrial fibrillation (AF) after cardiac surgery.Material and methods24 patients with new onset AF after aortic valve surgery, coronary artery bypass surgery or combined procedures were evaluated in this study. Additional including criteria were age between 18 and 80, duration of AF less than four days, body weight less than 100 kg and no previous treatment with class I or III antiarrhythmic drugs. Exclusion criteria were poor left ventricular ejection fraction (LVEF < 40%) and history of myocardial infarction within 30 days. The patients were divided into converters and non-converters according to their response to combination treatment with vernakalant and flecainide, and the groups were compared.ResultsThe mean age of the population was 69.6 ± 6.3 years and 26.1% of patients were female. There were no statistically significant differences between the two groups in terms of height, weight, gender distribution, comorbidities, preoperative medication, left ventricular function and left atrium diameter. Interventricular septum (IVS) in the non-converted group was significantly thicker compared to the converted group: 14.0 ± 1.00 vs. 10.40 ± 2.59 mm (p = 0.036). While 14 patients (60.9%) were successfully converted into stable sinus rhythm by pharmacological treatment with vernakalant and flecainide, 9 patients (39.1%, non-converted group) remained in AF. However, seven of them could be converted after additional EC.ConclusionThe combination of vernakalant and flecainide improves the conversion rate into a stable sinus rhythm in postcardiotomy patients with new onset AF compared to single drug therapy. Furthermore it might be an excellent precondition for successful EC in patients who are not converted after using both antiarrhtythmic drugs. Furthermore, left ventricular hypertrophy might be a potential negative predictor of successful pharmacological cardioversion.

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New Onset Postoperative Atrial Fibrillation is Associated with a Long-Term Risk for Stroke and Death Following Cardiac Surgery

Abstract: Patients with NwAfib perioperatively have increased risk of stroke and early death after discharge independent of other clinical risk factors.

Cited by 88 publications

References 16 publications

Perioperative Atrial Fibrillation and the Long-term Risk of Ischemic Stroke

Perioperative Atrial Fibrillation and the Long-term Risk of Ischemic Stroke

Predicting New-Onset Postoperative Atrial Fibrillation in Cardiac Surgery Patients

A novel treatment strategy of new onset atrial fibrillation after cardiac surgery: an observational prospective study

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