Long Term Outcome of Postoperative Atrial Fibrillation After Cardiac Surgery—A Propensity Score-Matched Cohort Analysis

Hsu, Jung‐Chi; Huang, Chen‐Yu; Chuang, Shu‐Lin; Yu, Hsu-Yu; Chen, Yih‐Sharng; Wang, Chih‐Hsien; Lin, Li-Chun

doi:10.3389/fcvm.2021.650147

Cited by 13 publications

(11 citation statements)

References 34 publications

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“…But we saw a statistically significant difference with a threefold increase in death among patients that developed POAF post-CABG. Our finding concurs with a recent paper by Emma Thorén et al [83] where POAF was associated with mortality with a more recent paper from Taiwan which also concluded that in the Asian population, POAF is significantly correlated with an overall mortality [84].…”

Section: Post-operative Outcomessupporting

confidence: 93%

Incidence and Outcomes of Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting of a Randomized Controlled Trial: A Blinded End-of-cycle Analysis

Musa¹,

Dillon²,

Taib³

et al. 2022

Rev. Cardiovasc. Med.

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Objective:The objective of this study is to analyse the incidence of postoperative atrial fibrillation (POAF), demography, post-operative outcomes including morbidity and mortality, length of Cardiac Intensive Care Unit (CICU) stay, High Dependency Unit (HDU) stay, and total hospital stay in patients undergoing coronary bypass grafting (CABG) at Institut Jantung Negana (IJN). Methods: We conducted a prospective, randomised, controlled trial. We supplied the treatment group with Tocovid capsules and the control group with placebo containing palm superolein. Results: Since January 2019, we have recruited the target population of 250 patients. However, the result is still blinded as we are still analysing blood samples for tocotrienol levels. 89.2% of patients completed the study with a 3.6% mortality and a 7.6% attrition rate. 35.2% of the patients developed POAF, the mean time being 46.06 ± 26.96 hours post-CABG. We did not observe any statistically significant difference when we compared left atrial size, New York Heart Association (NYHA) functional class, ejection fraction and premorbid history, besides EuroSCORE II (The European System for Cardiac Operative Risk Evaluation II) status except for older age group, right atrial size, and pleural effusion. There was also no difference in bypass time, cross clamp time or number of anastomoses. However, we noted a significant difference in death (p = 0.01) and renal failure requiring dialysis (p = 0.007) among patients with POAF; those patients also had a longer CICU stay (p = 0.005), HDU stay (p = 0.02), and total hospital stay (p = 0.001). Conclusions: POAF is associated with a higher incidence of renal failure and death while it increases CICU, HDU, and total hospital stay. It remains to be seen whether Tocovid reduces POAF and its associated sequelae. Clinical Trial Registration: NCT03807037 (Registered on 16 January 2019).

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Section: Post-operative Outcomessupporting

confidence: 93%

Incidence and Outcomes of Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting of a Randomized Controlled Trial: A Blinded End-of-cycle Analysis

Musa¹,

Dillon²,

Taib³

et al. 2022

Rev. Cardiovasc. Med.

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“…Among the 8974 identified (6212 screened) articles, a total of 59 studies published between 1993 and 2022 were included in the present analysis. 3 , 4 , 5 , 7 , 12 , 13 , 14 , 15 , 16 , 17 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , ...…”

Section: Resultsmentioning

confidence: 99%

Differences in Postoperative Atrial Fibrillation Incidence and Outcomes After Cardiac Surgery According to Assessment Method and Definition: A Systematic Review and Meta‐Analysis

Perezgrovas‐Olaria,

Alzghari,

Rahouma

et al. 2023

JAHA

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Background Postoperative atrial fibrillation (POAF) is the most frequent complication of cardiac surgery. Despite clinical and economic implications, ample variability in POAF assessment method and definition exist across studies. We performed a study‐level meta‐analysis to evaluate the influence of POAF assessment method and definition on its incidence and association with clinical outcomes. Methods and Results A systematic literature search was conducted to identify studies comparing the outcomes of patients with and without POAF after cardiac surgery that also reported POAF assessment method. The primary outcome was POAF incidence. The secondary outcomes were in‐hospital mortality, stroke, intensive care unit length of stay, and postoperative length of stay. Fifty‐nine studies totaling 197 774 patients were included. POAF cumulative incidence was 26% (range: 7.3%–53.1%). There were no differences in POAF incidence among assessment methods (27%, [range: 7.3%–53.1%] for continuous telemetry, 27% [range: 7.9%–50%] for telemetry plus daily ECG, and 19% [range: 7.8%–42.4%] for daily ECG only; P >0.05 for all comparisons). No differences in in‐hospital mortality, stroke, intensive care unit length of stay, and postoperative length of stay were found between assessment methods. No differences in POAF incidence or any other outcomes were found between POAF definitions. Continuous telemetry and telemetry plus daily ECG were associated with higher POAF incidence compared with daily ECG in studies including only patients undergoing isolated coronary artery bypass grafting. Conclusions POAF incidence after cardiac surgery remains high, and detection rates are variable among studies. POAF incidence and its association with adverse outcomes are not influenced by the assessment method and definition used, except in patients undergoing isolated coronary artery bypass grafting.

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“…Many episodes of POAF are self-terminating and some are asymptomatic, but POAF has been associated with a four- to the five-fold risk of recurrent AF in the next 5 years. It has also been shown to be a risk factor for stroke, myocardial infarction, and death compared with non-postoperative AF patients [ 3 , 4 ]. The pathogenesis of POAF may be multifactorial.…”

Section: Discussionmentioning

confidence: 99%

“…The mechanisms of POAF are complex and incompletely defined, but include intraoperative and postoperative phenomena, such as inflammation, sympathetic activation, hypoxia, acidosis, oxidative stress, electrolyte abnormalities, and intra-atrial conduction delay that combine to trigger atrial fibrillation, often in the presence of pre-existing factors, making the atria vulnerable to atrial fibrillation induction and maintenance [ 1 , 2 ]. To prevent POAF, preoperative beta-blocker (propranolol, carvedilol plus N-acetyl cysteine) use is associated with a reduced incidence of postoperative AF, but not major adverse events such as death, stroke, or acute kidney injury [ 3 ]. Data for other interventions such as statins, magnesium, colchicine, posterior pericardiotomy, atrial pacing, and corticosteroids are not robust.…”

Section: Introductionmentioning

confidence: 99%

Association of postoperative atrial fibrillation with higher dosing ratios of protamine-to-heparin

Yamada

J²,

Kambara³

et al. 2023

J Extra Corpor Technol

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Background: Postoperative atrial fibrillation (POAF) is defined as new-onset AF in the immediate postoperative period. The relatively high incidence of POAF after cardiac surgery is well described, but pathophysiological mechanisms underlying the initiation, maintenance, and progression of POAF may be multifactorial and have not yet been comprehensively characterized. One of the mechanisms includes altered Ca2+ kinetics. Accumulating evidence has suggested that altered atrial cytosolic calcium handling contributes to the development of POAF, protamine reversibly modulates the calcium release channel/ryanodine receptor 2 (RyR2) and voltage-dependent cardiac RyR2. However, it is currently unknown whether such abnormalities contribute to the arrhythmogenic substrate predisposing patients to the development of POAF. Methods: We have retrospectively analyzed 147 patients who underwent cardiac surgery with cardiopulmonary bypass support. Of these, 40 patients were excluded from the analysis because of pre-existing AF. All patients received heparin followed by protamine at different dosing ratios of protamine-to-heparin, depending on the periods studied. Results: The dosing ratio of protamine-to-heparin = 1.0 was compared with higher dosing ratios of protamine-to-heparin >1.0 up to 1.7. POAF developed in 15 patients (15/107 = 14%), of these, 5 out of 57 patients (33.3%) in the dosing ratio of protamine-to-heparin = 1.0 and 10 out of 35 patients (66.7%) in the higher dosing ratios of protamine-to-heparin. Statistical significance was observed in patients with higher dosing ratios of protamine-to-heparin, compared with the dosing ratio of protamine-to-heparin = 1.0 (odds ratio = 3.890, 95% CI = 1.130–13.300, p-value = 0.031). When types of diseases were analyzed in terms of higher dosing ratios of protamine-to-heparin, only valvular disorders were significantly associated with POAF (p = 0.04). Conclusions: Protamine is clinically utilized to reverse heparin overdose and has been shown to display immunological and inflammatory alterations. However, its association with POAF has not been reported. Our results provide evidence that higher dosing ratios of protamine-to-heparin may increase the incidence of POAF.

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Long Term Outcome of Postoperative Atrial Fibrillation After Cardiac Surgery—A Propensity Score-Matched Cohort Analysis

Cited by 13 publications

References 34 publications

Incidence and Outcomes of Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting of a Randomized Controlled Trial: A Blinded End-of-cycle Analysis

Incidence and Outcomes of Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting of a Randomized Controlled Trial: A Blinded End-of-cycle Analysis

Differences in Postoperative Atrial Fibrillation Incidence and Outcomes After Cardiac Surgery According to Assessment Method and Definition: A Systematic Review and Meta‐Analysis

Association of postoperative atrial fibrillation with higher dosing ratios of protamine-to-heparin

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