Effect of Preoperative Atrial Fibrillation on Postoperative Outcome following Cardiac Surgery

Abstract

Atrial fibrillation remains the commonest arrhythmia encountered in cardiac surgery. Data on the effect of preoperative atrial fibrillation on postoperative outcome remain limited. We sought to assess the effects preoperative atrial fibrillation on patients' outcome following cardiac surgery. This is a retrospective review of prospectively collected departmental data of all patients who underwent cardiac surgery over 8-year period. Our cohort consisted of 3777 consecutive patients divided into atrial fibrillation (n = 413, 11%) and sinus rhythm (n = 3364, 89%). Postoperative complications and in-hospital mortality were analysed. Univariate analysis showed significantly increased mortality and major complications in atrial fibrillation compared to sinus rhythm patients. Using multiple logistic regression analysis and after accounting for Euro SCORE as a confounding variable, we found that preoperative atrial fibrillation significantly increases the risk of mortality (OR 1.7), low cardiac output state (OR 1.3), prolonged ventilation (OR 1.4), infective complication (OR 1.5), gastrointestinal complications (OR 2.0), and intensive care unit readmission (OR 1.6). Preoperative atrial fibrillation in cardiac surgery patients increases their risk of mortality and major complications following cardiac surgery. Surgical strategies such as Cox-Maze procedure may be beneficial in these patients.

Predictors and clinical implications of atrial fibrillation in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation

“…Atrial fibrillation (AF) in patients with aortic stenosis (AS) is an independent risk factor for adverse outcome and is associated with increased long‐term mortality and heart failure rates . The association between AS and AF is prevalent in the minority of patients selected to surgical aortic valve replacement with rates ranging from 8 to 13% . In these surgical series, baseline AF comprises a high‐risk group as it is associated with poor short‐ and long‐term outcomes .…”

“…The association between AS and AF is prevalent in the minority of patients selected to surgical aortic valve replacement with rates ranging from 8 to 13% . In these surgical series, baseline AF comprises a high‐risk group as it is associated with poor short‐ and long‐term outcomes .…”

Infectious Complications and Mortality after Noncardiac Surgery Associated with CHA2DS2-VASc Score: A Retrospective Cohort Study Based on a Real-world Database

“…Recent studies have reported that preoperative AF clearly increases the risk of perioperative stroke and adverse cardiovascular events, as well as short-term and long-term mortality [18,32,33]. Whether various CHA2DS2-VASc scores are correlated with other postoperative complications in AF patients undergoing noncardiac surgeries remains unclear.…”

Ultra fast-tracking versus a conventional strategy in valve replacement surgery

“…[4] Preoperative amiodarone in rapid AF has been found to be beneficial for rate control. [5] Prophylactic magnesium therapy in this subset of patients has been shown to reduce the incidence of postoperative AF.…”