New‐onset atrial fibrillation and outcomes following isolated coronary artery bypass surgery: A systematic review and meta‐analysis

Abstract

Prior meta‐analyses have shown that new‐onset atrial fibrillation (NOAF) occurs in up to 40% of patients following cardiac surgery and is associated with substantial major adverse cardiovascular events. The stroke and mortality implications of NOAF in isolated CABG without concomitant valve surgery is not known. We thought that NOAF would be associated with increased risk of stroke and mortality, even in patients undergoing isolated CABG. A blinded review of studies from MEDLINE, CENTRAL, and Web of Science was done by two independent investigators. Stroke, 30‐day/hospital mortality, long‐term cardiovascular mortality, and long‐term (>1 year) all‐cause mortality were analyzed. We used Review Manager Version 5.3 to perform pooled analysis of outcomes. Of 4461 studies identified, 19 studies (n = 129 628) met inclusion criteria. NOAF incidence ranged from 15% to 36%. NOAF was associated with increased risk of stroke (unadjusted OR 2.15 [1.82, 2.53] [P < .00001]; adjusted OR 1.88 [1.02, 3.46] [P = .04]). NOAF was associated with increased 30‐day/hospital mortality (OR 2.35 [1.67, 3.32] [P < .00001]) and long‐term cardiovascular mortality (OR 2.04 [1.35, 3.09] [P = .0007]) NOAF was associated with increased long‐term all‐cause mortality (unadjusted OR 1.79 [1.63, 1.96] [P < .00001]; adjusted OR 1.58 [1.24, 2.00] [P = .0002]). We found that the incidence of NOAF following isolated CABG is high and is associated with increased stroke rate and mortality. Early recognition and management of NOAF could improve outcomes.

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

“…The time to new-onset of POAF ranged from 2 to 4 days after CABG. Although only four of the nine studies in our analysis reported on this outcome, the range agrees with previously published findings [ 8 , 12 ]. This is an important perioperative period which includes the patient awakening from anesthesia, extubation, and postoperative care for the prevention of pulmonary complications.…”

“…In contrast, Zangrillo et al [ 23 ] included only patients who underwent isolated elective off-pump CABG and defined POAF as a condition detected by 12-lead EKG. Regardless of the variability among the included studies, the overall mean incidence of new-onset POAF of 32.4% across all participants is a matter of concern [ 8 , 14 ] which points to the need to reduce the incidence of POAF by building consensus to minimize technical variations in the procedure, such as use of CPB and correcting risk factors for POAF such as preoperative anemia.…”

“…However, the risk factors for new-onset POAF after CABG remain inconclusive. Systematic reviews regarding the relationship between POAF and adverse outcomes after CABG have largely focused on mortality [ 8 , 12 , 15 ]. One systematic review which did seek to identify risk factors for POAF after CABG included studies for only on-pump CABG with all types of cohort study designs [ 4 ].…”

“…Newonset postoperative atrial fibrillation (POAF) is the most common cardiac dysrhythmia to occur after CABG [6,7]. Defined as POAF developing within two to four days after CABG, new-onset POAF is identified in 10-40% of patients in the early postoperative period after CABG, with the peak onset at two days postoperatively [4,8]. POAF after CABG increases the length of postoperative hospital stay and is associated with an increased risk of hospital readmission, stroke, and early and late mortality [8][9][10].…”

Effect of Continuous Electrocardiogram Monitoring on Detection of Undiagnosed Atrial Fibrillation After Hospitalization for Cardiac Surgery

“…Our findings suggest that the incidence of POAF may decrease rapidly over time because the rate of AF detection markedly declined after the first 2 weeks of hospital discharge. However, previous studies 1,13,14,20,28 found an association between POAF and cardiovascular risk over longterm follow-up, when, presumably, POAF had largely resolved. Future research is needed to assess whether early anticoagulation may mitigate adverse short-term and long-term cardiovascular outcomes.…”