Perioperative risk factors for new-onset postoperative atrial fibrillation after coronary artery bypass grafting: a systematic review

Seo, Eun Ji; Hong, Jung-Wan; Lee, Hyeon-Ju; Son, Youn‐Jung

doi:10.1186/s12872-021-02224-x

Cited by 24 publications

(18 citation statements)

References 42 publications

(77 reference statements)

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“…Specifically, patients who undergo combined surgeries, such as a combined valve and coronary artery bypass graft (CABG) surgeries, are twice as likely to develop POAF, up to 60% [ 25 ]. CABG surgeries alone lead to a higher risk for developing POAF, and patients experience an increased risk of other complications from POAF [ 26 , 27 ]. An observational study following patients for 10 years post-CABG showed an increase in stroke, long-term AF, and overall and cardiac mortality [ 28 ].…”

Section: Methodsmentioning

confidence: 99%

Post-Operative Atrial Fibrillation: Current Treatments and Etiologies for a Persistent Surgical Complication

Lopes¹,

Agrawal²

2022

J Surg Res

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Post-operative atrial fibrillation (POAF) is a persistent and serious surgical complication that occur in 20-55% of cardiac surgery cases. POAF may lead to adverse health outcomes such as stroke, thromboembolism, cardiac arrest, and mortality, and may develop long-term. Patients have a 2-fold increase in mortality risk and spend about 3.7 more days in the hospital and $16,000 more in medical costs during their visit. The mechanisms and risk factors of POAF are still poorly understood, yet a strong foundation of how a disease process occurs is needed to provide the most effective treatment. Current mechanisms that are postulated to contribute to POAF include an increase in sympathetic tone, oxidative stress, local and systemic inflammation, a trigger that induces atrial substrate changes, a driver to sustain POAF, and electrolyte disturbances such as hypomagnesemia. While needing more research, current risk factors include age, male sex, history of myocardial infarction or heart failure, hypertension, diabetes, obesity, and COPD. Treatments mostly include prophylaxis of repurposed drugs such as beta-blockers, statins, oral anticoagulants, antiarrhythmics, and Vitamin D and electrolyte supplementation. Autonomic denervation has also been a promising preventative measure for patients undergoing cardiac surgery. This critical review article provides an up-to-date and comprehensive summary of the pathophysiology of POAF, current clinical risk factors and management for POAF and discusses new pathways for further investigation.

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Section: Methodsmentioning

confidence: 99%

Post-Operative Atrial Fibrillation: Current Treatments and Etiologies for a Persistent Surgical Complication

Lopes¹,

Agrawal²

2022

J Surg Res

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“…12 Among the variables of CHA2DS2--VASc score age, hypertension and low ejection fraction are considered as most consistent factors associated with post op atrial fibrillation after cardiac surgery. [13][14][15] But in our study we found only age as significant factor (p-value= 0.001) associated with POAF after CABG surgery. Other factors including hypertension and left ventricular dysfunction did not show any significant association.…”

Section: Discussionmentioning

confidence: 65%

Association of CHA2DS2-VASc Score with Post Cardiac Surgery Atrial Fibrillation: A Single Centre Study

Alam

Hussain²,

Masroor³

et al. 2022

PAFMJ

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Objective: To find out the association of CHA2DS2-VASc score with postoperative atrial fibrillation in cardiac surgery patients. Study Design: Analytical Cross-Sectional study. Place and Duration of Study: Cardiothoracic Anaesthesia and Adult Cardiac Critical Care department, Armed Forces Institute of Cardiology and National Institute of Heart Diseases (AFIC/NIHD), Rawalpindi Pakistan, from Feb 2022 to Apr 2022. Methodology: After IERB approval, 186 adult patients of POAF with the prevalence of 9.7%undergoing CABG surgery were included in the study. Their demographic data and CHA2DS2-VASc score, originally used to find the risk of stroke in patients with atrial fibrillation, was calculated pre-operatively. They were followed for 48 hours postoperatively for any episode of post op atrial fibrillation (POAF). Data including pre op drugs, type of surgery, number of grafts, inotropic support and POAF timing after surgery was recorded and analysed by SPSS v 21.0. Results: Incidence of POAF in our study patients was 17.2 %( n=32). Mean time of onset of POAF was 24.75±16.05 hours.Patients who developed POAF had higher CHA2DS2-VASc score 3.06±1.21 compared with those who did not develop POAF 2.61±0.97. This association was statistically significant (p-value=0.023). Among the variables of CHA2DS2-VASc score, age had significant association with POAF (p-value= 0.001). No difference was found between on pump vs off pump surgery in terms of POAF (p-value=0.539). Conclusion: This study found that CHA2DS2-VASc score has significant association with POAF after CABG surgery. It is a simple and easy scoring system which can be calculated in preoperative period. Patients at increased risk of POAF can be identified and given prophylactic treatment to reduce morbidity and mortality.

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“…Furthermore, PTE is the treatment of choice for CTEPH 5 which entails median sternotomy, cardiopulmonary bypass (CPB), and deep hypothermic circulatory arrest. The CPB and aortic cross‐clamp time were also associated with the development of POAF 15,19 . However, the incidence of POAF after PTE is not significantly higher than that after common cardiac surgery.…”

Section: Discussionmentioning

confidence: 97%

“…The CPB and aortic cross-clamp time were also associated with the development of POAF. 15,19 However, the incidence of POAF after PTE is not significantly higher than that after common cardiac surgery. A large retrospective study of 521 patients who underwent PTE at the University of California San Diego revealed that the incidence of AA after PTE was 24.2%.…”

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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Perioperative risk factors for new-onset postoperative atrial fibrillation after coronary artery bypass grafting: a systematic review

Cited by 24 publications

References 42 publications

Post-Operative Atrial Fibrillation: Current Treatments and Etiologies for a Persistent Surgical Complication

Post-Operative Atrial Fibrillation: Current Treatments and Etiologies for a Persistent Surgical Complication

Association of CHA2DS2-VASc Score with Post Cardiac Surgery Atrial Fibrillation: A Single Centre Study

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

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