Atrial Fibrillation Following Cardiac Surgery: A Retrospective Cohort Series

Abstract

Atrial fibrillation (AF) is a common postoperative complication of cardiac surgery, yet the prevention and treatment of postoperative AF remains controversial and varies among practitioners. The purpose of this study was to document the incidence and time of onset of postoperative AF in a cardiac surgical cohort, examine risk factors implicated in the occurrence of postoperative AF, and assess effectiveness of current treatment strategies implemented for postoperative AF. A retrospective health record review was conducted on 1078 adults following cardiac surgery. Data on demographic, preoperative, perioperative, and postoperative risk factors for postoperative AF, documented episodes of AF, and clinical outcomes were recorded. Overall incidence of postoperative AF was 39.6%: 57.6% after cardiac valve surgery, 69.3% after combined coronary artery bypass graft and valve surgery, and 33% after bypass graft surgery alone. The peak onset of postoperative AF occurred on the second postoperative day. Advancing age, history of AF, combined cardiac valve and coronary artery bypass graft surgery, and high Mg+2 levels on the third postoperative day were significant predictors of postoperative AF in this cohort. Length of hospitalization increased with the presence of postoperative AF. Findings corroborate that multiple factors play a role in the development of AF following cardiac surgery.

Long-Term Suppression of Atrial Fibrillation by Botulinum Toxin Injection Into Epicardial Fat Pads in Patients Undergoing Cardiac Surgery

“…AF is a common complication of cardiac surgery with an incidence of 10% to 50%. [1][2][3][4][5] In a recent study, Aranki et al 10 demonstrated that 70% of postoperative AF occurrence was clustered around the first 4 postoperative days, 94% being diagnosed in the first 6 days, and only 6% more than a week after surgery. Postoperative AF was more often seen in females and in older patients, especially those with a history of chronic heart failure.…”

“…A trial fibrillation (AF) is a common complication of cardiac surgery, [1][2][3] with an incidence of 10% to 50% and typical appearance at 2 to 5 days after surgery. 4,5 Postoperative AF may lead to serious complications, such as increased risk of acute kidney injury, hemodynamic instability, cardiac failure, stroke, and death.…”

Hyperkalemic cardioplegia for adult and pediatric surgery: end of an era?

“…About 10% of CABG surgery patients will have significant left ventricular dysfunction lasting several hours, days, or weeks (Weisel, 1993; Mangano, 1995; Spinale, 1999). Twenty five to 40% of patients will have post-operative atrial fibrillation (Aranki et al, 1996; Mathew et al, 2004), and in those patients undergoing combined CABG and valvular surgery the incidence may increase to 69% (Scherr et al, 2006). In the USA alone, atrial fibrillation costs healthcare providers over 1.5 billion dollars per year (Steinberg, 2004), and this cost likely doubles on a global scale.…”

A Randomized, Placebo‐Controlled Trial of Omega‐3 Fatty Acids for Inhibition of Supraventricular Arrhythmias After Cardiac Surgery: The FISH Trial

“…1–3 The incidence of postoperative AF (POAF) is 10% to 50% and is higher in elderly patients. 4,5 POAF usually occurs 2 to 5 days after CABG, may increase hospital costs and length of stay, and is associated with an increased risk of morbidity, mortality, stroke, ventricular arrhythmias, need for pacemaker therapy, and use of potentially proarrhythmic drugs.…”