Postoperative atrial fibrillation following cardiac surgery: a persistent complication

Abstract

Postoperative atrial fibrillation (POAF) is a common, expensive and potentially morbid complication following cardiac surgery. POAF occurs in around 35% of cardiac surgery cases and has a peak incidence on postoperative day 2. Patients who develop POAF incur on average $10 000-$20 000 in additional hospital treatment costs, 12-24 h of prolonged ICU time, and an additional 2 to 5 days in the hospital. POAF has been identified as an independent predictor of numerous adverse outcomes, including a 2- to 4-fold increased risk of stroke, reoperation for bleeding, infection, renal or respiratory failure, cardiac arrest, cerebral complications, need for permanent pacemaker placement, and a 2-fold increase in all-cause 30-day and 6-month mortality. The pathogenesis of POAF is incompletely understood but likely involves interplay between pre-existing physiological components and local and systemic inflammation. POAF is associated with numerous risk factors including advanced age, pre-existing conditions that cause cardiac remodelling and certain non-cardiovascular conditions. Clinical management of POAF includes both prophylactic and therapeutic measures, although the efficacy of many interventions remains in question. This review provides a comprehensive and up-to-date summary of the pathogenesis of POAF, outlines current clinical guidelines for POAF prophylaxis and management, and discusses new avenues for further investigation.

The role of the right atrium in development of postoperative atrial fibrillation: A speckle tracking echocardiography study

“…Its occurrence increases hospitalization duration and is associated with increased cardiovascular complications such as stroke. It has been suggested that LA structure and functions, echocardiographic variables such as ejection fraction or LV global strain, RV global strain, and sPAP could be associated with POAF . In our study, LAVi, LVGL, and sPAP were closely associated with POAF development, which is consistent with the literature data.…”

“…In patients with COPD, RA dilatation is associated with increased mortality. RAVi has been shown to be associated with poor clinical outcome in pre‐capillary pulmonary hypertension (PHT) patients, and RA volume may be a predictor of clinical deterioration in PHT patients …”

“…In our study, LAVi, LVGL, and sPAP were closely associated with POAF development, which is consistent with the literature data. The role of both the LA and ventricle in the development of AF has been extensively demonstrated . While LAVi was reported to have better predictive value than LVGLS in the estimation of POAF development in one study, another study reported that lower preoperative LVGLS could be associated with POAF .…”

Newly developed post-operative atrial fibrillation is associated with an increased risk of late recurrence of atrial fibrillation in patients who underwent open heart surgery: Long-term follow up

“…Advanced age is the most consistent predictor for the development of POAF [21]. Age related degenerative and inflammatory modifications in atrial anatomy and altered electrophysiological properties are preconditions for POAF with acute surgical trauma and inflammation likely providing the inciting factors for POAF [22,23]. However, advanced age was not an independent predictor for developing late AF in this study, suggesting ongoing risk of AF in POAF patients apart from traditional risk factors during long-term follow up.…”

Association of Surgical Left Atrial Appendage Occlusion With Subsequent Stroke and Mortality Among Patients Undergoing Cardiac Surgery

“…Recent studies suggested that patients who devel-oped postoperative AF incur a mean of $10000 to $20000 in additional hospital treatment costs, 12 to 24 hours of addi-tional intensive care unit time, and an additional 2 to 5 days in the hospital. 27 As such, the risk of subsequent AF needs to be discussed with patients during shared decision making.…”