The persistent problem of new-onset postoperative atrial fibrillation: A single-institution experience over two decades

Abstract

Objectives Postoperative atrial fibrillation (POAF) is the most common complication following cardiac surgery. A variety of POAF risk factors has been reported, but study results have been inconsistent or contradictory, particularly in patients with preexisting atrial fibrillation. The incidence of POAF was evaluated in a group of 10,390 cardiac surgery patients among a comprehensive range of risk factors to identify reliable predictors of POAF. Methods This 20-year retrospective study examined the relationship between POAF and demographic factors, preoperative health conditions and medications, operative procedures, and postoperative complications. Multivariate logistic regression models were used to evaluate potential predictors of POAF. Results Increasing age, mitral valve surgery (OR=1.91), left ventricular aneurysm repair (OR=1.57), aortic valve surgery (OR=1.52), race (Caucasian) (OR=1.51), use of cardioplegia (OR=1.36), use of an intra-aortic balloon pump (OR=1.28), previous congestive heart failure (OR=1.28), and hypertension (OR=1.15) were significantly associated with POAF. The nonlinear relationship between age and POAF revealed the acceleration of POAF risk in patients 55 or older. In patients undergoing coronary artery bypass grafting, increasing age and previous congestive heart failure were the only factors associated with a higher risk of POAF. There was no trend in incidence of POAF over time. No protective factors against POAF were detected, including commonly prescribed categories of medications. Conclusions The persistence of the problem of POAF, and the modest predictability using common risk factors, suggest that limited progress has been made in understanding its etiology and treatment.

Predictors of Postoperative Atrial Fibrillation after On-Pump Coronary Artery Bypass Grafting: Is Duration of Mechanical Ventilation Time a Risk Factor?

“…8,9) In the general population, the frequency of postoperative AF increases 24% for every 5-year increase in age and plateaus after the age of 80 years. 10) The cause of this relationship is the degenerating ultrastructural changes that occur in cardiac muscle during aging.…”

Atrial Fibrillation; To Determine the Frequency and Its Predisposing Factors in Patients After Coronary Artery Bypass Grafting.

“…The author found 10 to 65 % of patients developing AF post operatively depending on patient's profile, type of surgery, method of arrhythmia surveillance and definition of arrhythmia. 3 Patient undergoing CABG alone have lower incidence of post-operative AF than patients undergoing valve surgery or combined CABG-valve operations. The Meta analysis of 24 trails included in this study estimated the incidence of AF at 26.7% in patients undergoing CABG alone.…”

“…1,2 The incidence of AF has been estimated to be 26.7% in a metaanalysis of 24 trails. 3 Over the past decades the incidence of post CABG AF is continuously increasing. 3 For the development of postoperative AF with varied level of evidence many risk factors have been identified.…”

“…3 Over the past decades the incidence of post CABG AF is continuously increasing. 3 For the development of postoperative AF with varied level of evidence many risk factors have been identified. The strong association of prior AF, advanced age, male gender, obesity, postoperative beta blocker withdrawal have been established, while other factors such as congestive heart failure (CHF), chronic lung disease, systemic emboli, decreased (LV/EF), increased left atrial (LA) size, hypomagnesaemia, myocardial infarction peri and postoperative, prolong cross clamp and bypass time have shown less likely association with this arrhythmia.…”

Polymorphism of the Interleukin-6, Interleukin-10, Superoxide Dismutase and Angiotensin Converting Enzyme Genes, and the Risk of Atrial Fibrillation After Cardiosurgery

“…1). В нашем исследовании у пациентов с ПОФП при сравнении с группой без аритмии чаще отмечался III ФК ХСН, что сопоставимо с результатами Shen J, et al (2011) [8]. Также в нашей работе у больных с ПОФП наблюдалась большая длительность ИБС, что отра-жено Wasmer K, et al (2014) [9].…”