Optimising risk factors for atrial fibrillation post-cardiac surgery

Hagana, Arwa; Ulucay, Edagul; Zaman, Sadia; Ahmed, Amna; Harky, Amer

doi:10.1177/02676591211019319

Cited by 8 publications

(8 citation statements)

References 83 publications

(321 reference statements)

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“…It was found that AF was mainly detected in the first three days after the surgery, with most patients being diagnosed on the second day. The same results were reported by Gjerakaroska et al (Gjerakaroska-Radovikj et al, 2020) and Goulden et al (Goulden et al, 2022). Associated factors such as autonomic imbalance before surgery, increase in catecholamines, pericardial inflammation, and changes in volume and pressure due to fluid shift contribute to POAF (Chang et al, 2019;Douketis et al, 2019).…”

Section: Discussionsupporting

confidence: 80%

Prevalence and Risk Predictors of Post Operative Atrial Fibrillation After Heart Surgery Under CPB

ZAFAR¹,

AHMED²,

Ajmal³

2022

Biol Clin Sci Res J

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The current analysis was designed to assess the prevalence and risk predictors of atrial fibrillation after heart surgery performed under cardiopulmonary bypass (CPB). A descriptive observational study was conducted in the Cardiology Department of Faisalabad Cardiology Hospital, Faisalabad. A total of 150 patients older than 18 years old undergoing CABG and valvular surgery performed by cardiopulmonary bypass were included in the study. The association of POAF and risk factors, including age, LVEF<40%, history of diabetes, myocardialinfarction, beta-blocker therapy, COPD, aortic cross-clamp time, CPB time, inotropic, and ventilation support, was evaluated. The patients with no history of beta blockers showed less risk of developing AF (OR: 0.153); hence the use of beta-blockers is significantly associated with AF. Similarly, patients with LVEF less than 40% and inotropic support for 30 minutes also had less odds of AF (0.174, 0.127); hence these variables are also significantly associated with AF. A history of myocardial infarction increased the risk of AF to 6.27 times. Using a ventilatorfor> 24 hours increased the incidence of AF to 12.28 times. LVEF <40%, inotropic and ventilation support, myocardial infarction, and CPB time preoperatively are strong predictors of POAF after cardiac surgery.

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Section: Discussionsupporting

confidence: 80%

Prevalence and Risk Predictors of Post Operative Atrial Fibrillation After Heart Surgery Under CPB

ZAFAR¹,

AHMED²,

Ajmal³

2022

Biol Clin Sci Res J

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“…Understandably, the longer the operation, the more severe the risk factors such as ischemic injury or inflammation experienced by the patient ( 41 ). Notably, we did not find that the duration of cardiopulmonary bypass time and aortic cross-clamp time was significantly correlated with PAOF, which is varied in some previous studies ( 45 , 46 ). Therefore, apart from the duration of cardiopulmonary bypass and aortic cross-clamp, the effects and underlying mechanisms of other possible factors in the duration of surgery on POAF, such as the use of anesthetics, deserve further study in the future.…”

Section: Discussioncontrasting

confidence: 79%

A novel predictive model for new-onset atrial fibrillation in patients after isolated cardiac valve surgery

Heng

Chen

Yang

et al. 2022

Front. Cardiovasc. Med.

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BackgroundPostoperative atrial fibrillation (POAF) is a severe complication after cardiac surgery and is associated with an increased risk of ischemic stroke and mortality. The main aim of this study was to identify the independent predictors associated with POAF after isolated valve operation and to develop a risk prediction model.MethodsThis retrospective observational study involved patients without previous AF who underwent isolated valve surgery from November 2018 to October 2021. Patients were stratified into two groups according to the development of new-onset POAF. Baseline characteristics and perioperative data were collected from the two groups of patients. Univariate and multivariate logistic regression analyses were applied to identify independent risk factors for the occurrence of POAF, and the results of the multivariate analysis were used to create a predictive nomogram.ResultsA total of 422 patients were included in the study, of which 163 (38.6%) developed POAF. The Multivariate logistic regression analysis indicated that cardiac function (odds ratio [OR] = 2.881, 95% confidence interval [CI] = 1.595–5.206; P < 0.001), Left atrial diameter index (OR = 1.071, 95%CI = 1.028–1.117; P = 0.001), Operative time (OR = 1.532, 95%CI = 1.095–2.141; P = 0.013), Neutrophil count (OR = 1.042, 95%CI = 1.006–1.08; P = 0.021) and the magnitude of fever (OR = 3.414, 95%CI = 2.454–4.751; P < 0.001) were independent predictors of POAF. The above Variables were incorporated, and a nomogram was successfully constructed with a C-index of 0.810. The area under the receiver operating characteristic curve was 0.817.ConclusionCardiac function, left atrial diameter index, operative time, neutrophil count, and fever were independent predictors of POAF in patients with isolated valve surgery. Establishing a nomogram model based on the above predictors helps predict the risk of POAF and may have potential clinical utility in preventive interventions.

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“…Furthermore, the AUC of the resting heart rate is slightly greater than that for age, which is a well-established risk factor for POAF. [14][15][16] To the best of our knowledge, this is the first study to capture the value of the resting heart rate for predicting POAF in CTEPH patients who underwent PTE.…”

Section: Discussionmentioning

confidence: 99%

“…Advanced age has consistently been found to be an independent predictor of POAF, and the incidence of POAF among patients aged 72 or older is fivefold higher than that of patients aged 55 and younger. 16 Studies showed that age-related atrial myocardium remodeling played an important role in the development of AF. 26,27 CTEPH patients who underwent PTE tend to be younger than other cardiac surgery patients, the mean age of the patients in this study was only 51 ± 13 years.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, preoperative identification of patients at high risk of developing POAF is crucial to improving the prognosis and quality of life of CTEPH patients. Advanced age has consistently been found to be an independent predictor of POAF, and the incidence of POAF among patients aged 72 or older is fivefold higher than that of patients aged 55 and younger 16 . Studies showed that age‐related atrial myocardium remodeling played an important role in the development of AF 26,27 .…”

Section: Discussionmentioning

confidence: 99%

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Resting heart rate as a preoperative predictor of postoperative atrial fibrillation after pulmonary thromboendarterectomy

Zhen

Lin

et al. 2022

Journal of Cardiac Surgery

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Background As a marker of the autonomic nervous system, resting heart rate is a predictor of postoperative atrial fibrillation (POAF). However, its predictive value for POAF after pulmonary thromboendarterectomy (PTE) has not been adequately studied. Methods We enrolled 97 patients who underwent PTE in our hospital from December 2016 to November 2021 in this retrospective study. Almost all preoperative characteristics, including electrocardiogram, demographics, hematologic and biochemical indices, echocardiography, and pulmonary hemodynamics, were compared between patients with and without POAF. Multivariate logistic regression analysis was used to identify the independent risk factors for POAF after PTE. Results Overall, 21 patients (21.6%) suffered from POAF after PTE. Compared with patients without POAF, those with POAF were older (p = .049), with a higher resting heart rate (p = .012), and higher platelet count (p = .040). In the binary logistic regression analysis, the resting heart rate (odds ratio [OR] = 1.043, 95% confidence interval [CI] = 1.009–1.078, p = .012) and age (OR = 1.051, 95% CI = 1.003–1.102, p = .037) were independent risk factors for POAF after PTE. The optimal cutoff point of resting heart rate was 89.5 with sensitivity and specificity of 47.6% and 77.6%. When the cutoff value of the age was 54.5, its sensitivity for predicting POAF was 71.4%, with a specificity of 59.2%. Conclusions POAF is common after PTE surgery, and the incidence may be underestimated. The resting heart rate and age are independent preoperative risk factors for POAF after PTE. Considering the lower predictive power of the resting heart and age, further large‐scale studies are needed.

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Optimising risk factors for atrial fibrillation post-cardiac surgery

Cited by 8 publications

References 83 publications

Prevalence and Risk Predictors of Post Operative Atrial Fibrillation After Heart Surgery Under CPB

Prevalence and Risk Predictors of Post Operative Atrial Fibrillation After Heart Surgery Under CPB

A novel predictive model for new-onset atrial fibrillation in patients after isolated cardiac valve surgery

Resting heart rate as a preoperative predictor of postoperative atrial fibrillation after pulmonary thromboendarterectomy

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