Atrial fibrillation after cardiac surgery: A systematic review and meta-analysis

Abstract

Objective: New-onset post-operative atrial fibrillation (POAF) after cardiac surgery is common, with rates up to 60%. POAF has been associated with early and late stroke, but its association with other cardiovascular outcomes is less known. The objective was to perform a meta-analysis of the studies reporting the association of POAF with perioperative and long-term outcomes in cardiac surgery. M ethod s: We performed a systematic review and a meta-analysis of studies presenting outcomes for cardiac surgery based on the presence or absence of POAF. MEDLINE, EMBASE and Cochrane Library were assessed, 57 studies (246,340 patients) were selected. Peri-operative mortality was the primary outcome. Inverse variance method and random model were performed. Leave-one-out analysis, sub-group analyses and meta-regression were conducted. Results: POAF was associated with peri-operative mortality (odds ratio [OR]= 1.92, 95% confidence interval [CI] 1.58; 2.33), peri-operative stroke (OR= 2.17, 95% CI 1.90; 2.49), peri-operative myocardial infarction (OR= 1.28, 95% CI 1.06; 1.54), perioperative acute renal failure (OR= 2.74, 95% CI 2.42; 3.11), hospital (standardized mean difference [SMD]= 0.80, 95% CI 0.53; 1.07) and ICU stay (SMD= 0.55, 95% CI 0.24; 0.86), long-term mortality (incidence rate ratio [IRR]= 1.54, 95% CI 1.40; 1.69), long-term stroke (IRR= 1.33, 95% CI 1,21;1,46) and long-standing persistent atrial fibrillation (IRR= 4.73, 95% CI 3.36; 6.66). Con clusion :The results suggest that POAF in cardiac surgery is associated with an increased occurrence of most short and long-term cardiovascular adverse events. However, the causality of this association remains to be established.

The effects of vitamin D supplementation on postoperative atrial fibrillation after coronary artery bypass grafting in patients with vitamin D deficiency

“…Our trial revealed a lower incidence of POAF compared with other studies. 18,19 This is probably because of our strict inclusion and exclusion criteria, which eliminated patients at increased risk of POAF.…”

Cardiac Surgery 2021 Reviewed

“…Although POAF has been considered temporary and rather harmless, there was even an association with long-term mortality, stroke, and long-standing persistent atrial fibrillation. 20 Although a causal relationship between POAF and adverse events has not been established, the following randomized controlled trial 21 is important in this context because it shows an effective way to reduce POAF without increasing the risk of postoperative complications. The authors randomly assigned 420 adult patients without pre-existing atrial fibrillation to undergo posterior left pericardiotomy or no intervention during elective cardiac surgery.…”

In-depth characterization of a mouse model of postoperative atrial fibrillation

“…One important risk factor for AF is surgery, and AF developing during the days following surgery is termed postoperative AF (POAF). POAF typically occurs 1-3 days after surgery [ 3 ] and portends a 5-fold higher risk of chronic AF [ 4 ] and a 2-fold higher risk of stroke and mortality [ 5 , 6 ] . Rates of POAF are 15%-42% after cardiac surgery [ 7 ] and 10%-20% after non-cardiac surgery [ 6 , 8 , 9 ] .…”