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Madsen CL, Leerhøy B, Jørgensen LN, Meyhoff CS, Sajadieh A, Domínguez H. Frequency and risk factors of atrial fibrillation after acute abdominal surgery: A prospective cohort study. Acta Anaesthesiol Scand 2024; 68:345-353. [PMID: 37975533 DOI: 10.1111/aas.14360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 11/01/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND AND AIM Scarce data exist on the true incidence of postoperative atrial fibrillation (POAF) after acute abdominal surgery and associated outcomes. The current study aimed to identify the frequencies of clinically recognized POAF and associated complications, along with their risk factors. METHODS This study was a prospective, single-center cohort study of unselected adult patients referred for acute abdominal surgery during a 3-month period. Through careful review, demographics, comorbidity, and surgical characteristics were prospectively drawn from medical charts. The primary outcome was clinically recognized POAF occurring in-hospital. Logistic regression was used to determine the risk factors of POAF and associated complications. A subgroup was enrolled in a feasibility study of peri- and postoperative continuous cardiac rhythm monitoring. RESULTS In total, 450 patients were enrolled. Clinically recognized in-hospital POAF was observed in 22 patients (4.9%). All cases were observed in patients aged ≥60 years, corresponding to 22 of 164 patients (13.4%). Multiple risk factors were observed, such as age, prior atrial fibrillation, heart failure, hypertension, diabetes mellitus, chronic renal disease, and major (vs. minor) surgery. POAF was associated with severe in-hospital complications (POAF group 45.5% vs. non-POAF group 8.6%, p < .001) and in-hospital mortality (POAF group 13.6% vs. non-POAF group 3.0%, p = .043). In total, 295 patients were monitored by continuous cardiac rhythm monitoring for 12,148 h, yielding five patients with asymptomatic AF. CONCLUSIONS In conclusion, this prospective study of POAF in patients undergoing acute abdominal surgery showed that one in 20 patients developed clinically recognized in-hospital POAF. Multiple risk factors of POAF were identified. POAF was associated with severe complications up to 30 days after surgery.
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Affiliation(s)
- Christoffer L Madsen
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bonna Leerhøy
- Digestive Disease Centre, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Lars N Jørgensen
- Digestive Disease Centre, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Christian S Meyhoff
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ahmad Sajadieh
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Helena Domínguez
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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Rühlmann F, Engelhardt D, Mackert AF, Hedicke MS, Tichelbäcker T, Leha A, Bernhardt M, Ghadimi M, Perl T, Azizian A, Gaedcke J. Short- and Long-Term Outcomes of Patients with Postoperative Arrhythmia after Liver Surgery. Biomedicines 2024; 12:271. [PMID: 38397873 PMCID: PMC10886928 DOI: 10.3390/biomedicines12020271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/02/2024] [Accepted: 01/19/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND New-onset postoperative arrhythmia (PA) has previously been described as a pivotal risk factor for postoperative morbidity and mortality after visceral surgery. However, there is a lack of data concerning liver surgery. The incidence and impact of new-onset postoperative arrhythmia after liver surgery was, therefore, analyzed in a monocentric study. METHODS In total, n = 460 patients (221 female, 239 male) who underwent liver surgery between January 2012 and April 2020 without any prior arrhythmia in their medical history were included in this retrospective analysis. Clinical monitoring started with the induction of anesthesia and was terminated with discharge from the intensive care unit (ICU) or intermediate care unit (IMC). Follow-up included documentation of complications during the hospital stay, as well as long-term survival analysis. RESULTS Postoperative arrhythmia after liver surgery was observed in 25 patients, corresponding to an incidence of 5.4%. The occurrence of arrhythmia was significantly associated with intraoperative complications (p < 0.05), liver fibrosis/cirrhosis (p < 0.05), bile fistula/bile leakage/bilioma (p < 0.05), and organ failure (p < 0.01). Survival analysis showed a significantly poorer overall survival of patients who developed postoperative arrhythmia after liver surgery (p < 0.001). CONCLUSIONS New-onset postoperative arrhythmia after liver surgery has an incidence of only 5.4% but is significantly associated with higher postoperative morbidity and poorer overall survival.
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Affiliation(s)
- Felix Rühlmann
- Department of General, Visceral and Paediatric Surgery, University Medical Centre Göttingen, 37075 Göttingen, Germany; (F.R.); (D.E.); (A.F.M.); (M.S.H.); (M.B.); (M.G.); (T.P.); (A.A.)
| | - Deborah Engelhardt
- Department of General, Visceral and Paediatric Surgery, University Medical Centre Göttingen, 37075 Göttingen, Germany; (F.R.); (D.E.); (A.F.M.); (M.S.H.); (M.B.); (M.G.); (T.P.); (A.A.)
| | - Alma Franziska Mackert
- Department of General, Visceral and Paediatric Surgery, University Medical Centre Göttingen, 37075 Göttingen, Germany; (F.R.); (D.E.); (A.F.M.); (M.S.H.); (M.B.); (M.G.); (T.P.); (A.A.)
| | - Mara Sophie Hedicke
- Department of General, Visceral and Paediatric Surgery, University Medical Centre Göttingen, 37075 Göttingen, Germany; (F.R.); (D.E.); (A.F.M.); (M.S.H.); (M.B.); (M.G.); (T.P.); (A.A.)
| | - Tobias Tichelbäcker
- Clinic III for Internal Medicine, Heart Centre of University Hospital of Cologne, 50937 Cologne, Germany;
| | - Andreas Leha
- Institute of Medical Statistics, University Medical Centre Göttingen, 37075 Göttingen, Germany;
| | - Markus Bernhardt
- Department of General, Visceral and Paediatric Surgery, University Medical Centre Göttingen, 37075 Göttingen, Germany; (F.R.); (D.E.); (A.F.M.); (M.S.H.); (M.B.); (M.G.); (T.P.); (A.A.)
| | - Michael Ghadimi
- Department of General, Visceral and Paediatric Surgery, University Medical Centre Göttingen, 37075 Göttingen, Germany; (F.R.); (D.E.); (A.F.M.); (M.S.H.); (M.B.); (M.G.); (T.P.); (A.A.)
| | - Thorsten Perl
- Department of General, Visceral and Paediatric Surgery, University Medical Centre Göttingen, 37075 Göttingen, Germany; (F.R.); (D.E.); (A.F.M.); (M.S.H.); (M.B.); (M.G.); (T.P.); (A.A.)
| | - Azadeh Azizian
- Department of General, Visceral and Paediatric Surgery, University Medical Centre Göttingen, 37075 Göttingen, Germany; (F.R.); (D.E.); (A.F.M.); (M.S.H.); (M.B.); (M.G.); (T.P.); (A.A.)
| | - Jochen Gaedcke
- Department of General, Visceral and Paediatric Surgery, University Medical Centre Göttingen, 37075 Göttingen, Germany; (F.R.); (D.E.); (A.F.M.); (M.S.H.); (M.B.); (M.G.); (T.P.); (A.A.)
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Jiang S, Liao X, Chen Y, Li B. Exploring postoperative atrial fibrillation after non-cardiac surgery: mechanisms, risk factors, and prevention strategies. Front Cardiovasc Med 2023; 10:1273547. [PMID: 38130687 PMCID: PMC10733488 DOI: 10.3389/fcvm.2023.1273547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Atrial fibrillation (AF) stands as the most prevalent persistent arrhythmia and a common complication after surgical procedures. Although the majority of non-cardiac surgery patients experience postoperative AF (POAF) and the condition is typically self-limited and asymptomatic, its detrimental impact on patient outcomes, prolonged hospitalization, and heightened risk of stroke and overall mortality has become increasingly evident. Of significant concern, POAF emerges as a noteworthy risk factor for stroke, myocardial infarction, and mortality in comparison to patients with non-surgical atrial fibrillation. Multiple studies have corroborated the association between POAF and an elevated risk of stroke and mortality. The development of postoperative atrial fibrillation is multifactorial, with the inflammatory response being a primary contributor; additionally, factors such as hypovolemia, intraoperative hypotension, anemia, trauma, and pain can trigger POAF. Risk factors for POAF in non-cardiac surgery primarily relate to age, hypertension, obesity, prior cardiac disease, obstructive sleep apnea, and male sex. Prophylactic treatment with β-blockers, amiodarone, or magnesium has demonstrated efficacy, but further trials are warranted, especially in high-risk populations. This review provides an account of the incidence rate, pathophysiology, and prognosis of atrial fibrillation after non-cardiac surgery, elucidates the underlying mechanisms of its occurrence, and explores various preventive strategies investigated in this domain.
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Affiliation(s)
- Shengjie Jiang
- Department of Anesthesiology, Zhongshan City People’s Hospital, Zhongshan, Guangdong, China
| | | | | | - Binfei Li
- Department of Anesthesiology, Zhongshan City People’s Hospital, Zhongshan, Guangdong, China
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Tsochatzis EA, Watt KD, VanWagner LB, Verna EC, Berzigotti A. Evaluation of recipients with significant comorbidity - Patients with cardiovascular disease. J Hepatol 2023; 78:1089-1104. [PMID: 37208096 DOI: 10.1016/j.jhep.2023.03.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/24/2023] [Accepted: 03/26/2023] [Indexed: 05/21/2023]
Abstract
Liver transplant(ation) (LT) is the most effective treatment for patients with decompensated liver disease. The increasing prevalence of obesity and type 2 diabetes and the growing number of patients with non-alcoholic fatty liver disease being evaluated for LT, have resulted in a greater proportion of LT candidates presenting with a higher risk of cardiovascular disease. As cardiovascular disease is a major cause of morbidity and mortality after LT, a thorough cardiovascular evaluation pre-LT is crucial. In this review, we discuss the latest evidence on the cardiovascular evaluation of LT candidates and we focus on the most prevalent conditions, namely ischaemic heart disease, atrial fibrillation and other arrhythmias, valvular heart disease, and cardiomyopathies. LT candidates undergo an electrocardiogram, a resting transthoracic echocardiography and an assessment of their cardiopulmonary functional ability as part of their standardised pre-LT work-up. Further diagnostic work-up is undertaken based on the results of the baseline evaluation and may include a coronary computed tomography angiography in patients with cardiovascular risk factors. The evaluation of potential LT candidates for cardiovascular disease requires a multidisciplinary approach, with input from anaesthetists, cardiologists, hepatologists and transplant surgeons.
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Affiliation(s)
- Emmanuel A Tsochatzis
- UCL Institute for Liver and Digestive Health, Royal Free Campus, London, UK; Sheila Sherlock Liver Unit, Royal Free Hospital, London, UK.
| | - Kymberly D Watt
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Lisa B VanWagner
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Elizabeth C Verna
- Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, New York, New York, USA
| | - Annalisa Berzigotti
- Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
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Vandenberk B, Altieri MH, Liu H, Raj SR, Lee SS. Review article: diagnosis, pathophysiology and management of atrial fibrillation in cirrhosis and portal hypertension. Aliment Pharmacol Ther 2023; 57:290-303. [PMID: 36571829 DOI: 10.1111/apt.17368] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/16/2022] [Accepted: 12/08/2022] [Indexed: 01/16/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common arrhythmia and its management in cirrhosis can be challenging due to the altered hepatic metabolism of medications and increased risk of bleeding. AIMS To provide a comprehensive overview of the diagnosis, pathophysiology and management of AF in patients with cirrhosis from both a cardiology and a hepatology perspective. METHODS An extensive literature search was performed using the terms 'atrial fibrillation' and 'cirrhosis'. Guideline documents and consensus statements were explored. RESULTS The prevalence of AF in patients with cirrhosis ranges between 6.6% and 14.2%, while the incidence of new-onset AF in the post-operative period after liver transplant ranged between 6.8% and 10.2%. AF in patients with cirrhosis is associated with adverse outcomes in both pre-transplant and post-transplant settings, including an increased risk of stroke when compared to the general population. We review the pathogenesis of AF in general and in cirrhosis. This review also provides guidance on the management of AF, including the use of anticoagulation and rate versus rhythm control. In the absence of strict contraindications, all patients with cirrhosis and AF should be anticoagulated. The use of DOACs is preferred over vitamin K antagonists. In patients with a high bleeding risk, a DOAC with an approved antidote may be preferred. CONCLUSIONS Atrial fibrillation is increased in patients with cirrhosis. AF management requires careful consideration of treatment options. Since patients with cirrhosis were excluded from all major randomised clinical trials, dedicated research on the pathophysiology and management of AF in cirrhosis is needed.
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Affiliation(s)
- Bert Vandenberk
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Mario H Altieri
- Division of Gastroenterology, Hepatology and Nutrition, CHU Caen, Caen, France
| | - Hongqun Liu
- Liver Unit, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Satish R Raj
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Samuel S Lee
- Liver Unit, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Rivas E, Sasaki K, Liang C, Wang J, Quintini C, Maheshwari K, Turan A, Fares M, Cywinski JB. New-Onset Atrial Fibrillation in Patients Undergoing Liver Transplantation: Retrospective Analysis of Risk Factors and Outcomes. J Cardiothorac Vasc Anesth 2022; 36:4100-4107. [PMID: 35999113 DOI: 10.1053/j.jvca.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/08/2022] [Accepted: 07/10/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The authors aimed to identify predictors of new-onset postoperative atrial fibrillation (POAF) during the initial 90 days following liver transplantation, and to assess the association between POAF in-hospital and 1-year mortality. DESIGN A retrospective cohort study. SETTING At a university hospital between 2005 and 2017. PATIENTS Adults without a history of preoperative atrial fibrillation who underwent orthotopicliver transplantation. MEASUREMENT AND MAIN RESULTS The authors assessed the univariate association between new-onset of POAF in the postoperative period and each potential factor through a logistic regression model. Moreover, they explored predictors for POAF through stepwise selection. Finally, the authors assessed the relationship between POAF and in-hospital and 1-year mortality using logistic regression models, and whether the duration of atrial fibrillation was associated with in-hospital and 1-year mortality. Among 857 patients, 89 (10.4%) developed POAF. Using only preoperative variables, pulmonary hypertension, age, Model for End-Stage Liver Disease (MELD) score, and White race were identified as the most important predictors. Model discrimination was 0.75 (95% CI: 0.69-0.80), and incorporating intraoperative variables was 0.77 (95% CI: 0.72-0.82). In-hospital mortality was observed in 7.2% (6/83) of patients with new-onset of POAF, and in 2.8% (22/768) without, with confounder-adjusted odds ratio (OR) 1.00 (97.5% CI: 0.29,3.45; p = 0.996). One-year mortality was 22.4% (20/89) in patients who developed POAF and 8.3% (64/768) in patients who did not, confounder-adjusted OR 2.64 (97.5% CI: 1.35-5.16; p = 0.001). The duration of POAF did not affect long-term postoperative mortality. CONCLUSION Preoperative, mostly unmodifiable comorbidities are important risk factors for new-onset POAF after liver transplantation. The POAF was not associated with in-hospital mortality, but with increased 1-year mortality. Once developed, the duration of POAF did not affect long-term mortality after a liver transplant.
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Affiliation(s)
- Eva Rivas
- Department of OUTCOMES RESEARCH, Cleveland Clinic, Cleveland, OH; Department of Anesthesia, Hospital Clinic of Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Kazunari Sasaki
- Department of Liver Transplant, Cleveland Clinic, Cleveland, OH
| | - Chen Liang
- Department Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Jiayi Wang
- Department of OUTCOMES RESEARCH, Cleveland Clinic, Cleveland, OH
| | | | - Kamal Maheshwari
- Department of OUTCOMES RESEARCH, Cleveland Clinic, Cleveland, OH; Department of General Anesthesia, Cleveland Clinic, Cleveland, OH
| | - Alparslan Turan
- Department of OUTCOMES RESEARCH, Cleveland Clinic, Cleveland, OH; Department of General Anesthesia, Cleveland Clinic, Cleveland, OH
| | - Maan Fares
- Department of Cardiology, Cleveland Clinic, Cleveland, OH
| | - Jacek B Cywinski
- Department of OUTCOMES RESEARCH, Cleveland Clinic, Cleveland, OH; Department of General Anesthesia, Cleveland Clinic, Cleveland, OH.
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Li X, Wang X, Guan Z. New onset atrial fibrillation during orthotopic liver transplantation induced by iced saline injection for transpulmonary thermodilution: a case report. J Int Med Res 2022; 50:3000605221132711. [PMID: 36268764 PMCID: PMC9597047 DOI: 10.1177/03000605221132711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Transpulmonary thermodilution is often used to measure extravascular lung water
during liver transplantation. Here, the case of new onset atrial fibrillation
during orthotopic liver transplantation, which may have been induced by iced
saline injection for transpulmonary thermodilution measurement, is described. A
52-year-old male patient underwent orthotopic liver transplantation due to
alcoholic cirrhosis combined with portal hypertension. During dissection of the
recipient liver, transpulmonary thermodilution was performed. At 3 minutes
following iced saline injected, atrial fibrillation occurred, the ventricular
rate increased to more than 120 beats per min, and blood pressure dropped to
75/50 mmHg. Massive haemorrhage, inferior vena cava clamping, electrolyte
disorder, acid-base balance disorder, and hypothermia were all ruled out, and
iced saline injection was suspended. Hemodynamic stability was maintained with
phenylephrine and lanatocide C (cedilanid), and chemical cardioversion was
performed using amiodarone. During the reperfusion phase, transient hemodynamic
instability was managed by norepinephrine. The neohepatic phase was uneventful.
Atrial fibrillation lasted for 5 days and reversed to sinus rhythm
automatically. The patient was hemodynamically stable during this period, and
recovery was smooth with no thromboembolic events. In conclusion, atrial
fibrillation may be induced by iced saline injection for transpulmonary
thermodilution measurement during orthotopic liver transplantation.
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Affiliation(s)
- Xin Li
- Department of Anaesthesiology, the First Affiliated Hospital of
Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Xu Wang
- Department of Anaesthesiology, Qinghai Provincial People’s
Hospital, Xining, Qinghai Province, China
| | - Zheng Guan
- Department of Anaesthesiology, the First Affiliated Hospital of
Xi’an Jiaotong University, Xi’an, Shaanxi Province, China,Zheng Guan, Department of Anaesthesiology,
the First Affiliated Hospital of Xi’an Jiaotong University, 277 Yanta West Road,
Xi’an, Shaanxi Province 710061, China.
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So WZ, Tan FL, Tan DJH, Ng CH, Yong JN, Syn N, Tang ASP, Wong RC, Lin W, Tan EXX, Huang DQ, Dan YY, Chew NWS, Siddiqui MS, Muthiah MD. A systematic review and meta-analysis on the impact of pre-existing and new-onset atrial fibrillation on outcomes before and after liver transplantation. Dig Liver Dis 2022; 54:614-621. [PMID: 34896025 DOI: 10.1016/j.dld.2021.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/07/2021] [Accepted: 11/07/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Atrial Fibrillation (AF) is the most commonly diagnosed cardiac arrhythmia. It is associated with significant morbidity and mortality, as it is a major risk factor for cerebral vascular accidents (CVA). Our aim was to determine the prevalence of pre-existing and new-onset AF among patients undergoing liver transplantation (LT) and its impact on post-transplant outcomes. METHODS Medline and Embase were searched. Single-arm analysis was conducted using the generalized linear mixed model to determine the prevalence of pre-existing and new-onset AF. Logistic regression was performed to analyze risk factors. Comparative meta-analysis in odds ratio was conducted for binary outcomes. RESULTS Twenty articles were included, with 17 studies on pre-existing AF, and 7 including data on new-onset AF post-LT. The prevalence of pre-existing AF was 3.3% (CI 2.3-4.7) (14 studies, 45,070 patients) in pooled analysis. Significantly higher prevalence of pre-existing AF patients from North America was noted when compared to Europe (4.5%, CI 3.4-5.8 vs 1.5%, CI 0.8-2.7; p = 0.001). Body mass index (BMI), history of hypertension, diabetes, coronary artery disease (CAD), and cerebrovascular accidents (CVA) were risk factors for pre-existing AF. Pre-existing AF was significantly associated with major adverse cardiac or cerebrovascular events (MACCE) postoperatively (OR 8.02, 95%CI 5.40-11.90, p < 0.001). New-onset AF post-LT had an incidence of 6.8% (CI 4.9-9.3), and was associated with increased risk of mortality (OR 2.31, 95% CI 1.76-3.02, p < 0.001) and graft failure (OR 2.98, CI 1.99-4.47, p < 0.001). CONCLUSION AF is relatively more common among patients undergoing LT compared to the general non-transplant population. Additionally, it is associated with adverse outcomes including MACCE, thus warranting clinical attention. Thorough cardiac assessment, and close surveillance of post-operative AF may be clinically prudent.
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Affiliation(s)
- Wei Zheng So
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, 117597, Singapore
| | - Felicia Liying Tan
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, 117597, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, 117597, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, 117597, Singapore.
| | - Jie Ning Yong
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, 117597, Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, 117597, Singapore; Biostatistics and Modelling Domain, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Ansel Shao Pin Tang
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, 117597, Singapore
| | - Raymond C Wong
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, 117597, Singapore; Department of Cardiology, National University Heart Center, Singapore
| | - Weiqin Lin
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, 117597, Singapore; Department of Cardiology, National University Heart Center, Singapore
| | - Eunice Xiang Xuan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, 117597, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Tower Block Level 10, 1E Kent Ridge Road, 119228, Singapore; National University Center for Organ Transplantation, National University Health System, Singapore
| | - Daniel Q Huang
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, 117597, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Tower Block Level 10, 1E Kent Ridge Road, 119228, Singapore; National University Center for Organ Transplantation, National University Health System, Singapore
| | - Yock Young Dan
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, 117597, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Tower Block Level 10, 1E Kent Ridge Road, 119228, Singapore; National University Center for Organ Transplantation, National University Health System, Singapore
| | - Nicholas W S Chew
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, 117597, Singapore; Department of Cardiology, National University Heart Center, Singapore
| | - Mohammad Shadab Siddiqui
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Mark D Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, 117597, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Tower Block Level 10, 1E Kent Ridge Road, 119228, Singapore; National University Center for Organ Transplantation, National University Health System, Singapore.
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Fan K, Chen L, Liu F, Ding X, Yan P, Gao M, Yu W, Liu H, Yu Y. Predicting New-Onset Postoperative Atrial Fibrillation Following Isolated Coronary Artery Bypass Grafting: Development and Validation of a Novel Nomogram. Int J Gen Med 2022; 15:937-948. [PMID: 35115819 PMCID: PMC8801512 DOI: 10.2147/ijgm.s346339] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/07/2022] [Indexed: 01/23/2023] Open
Abstract
Objective To select variables associated with new-onset postoperative atrial fibrillation (POAF) following isolated coronary artery bypass grafting (CABG) and develop a nomogram for risk prediction in a Chinese population. Methods The study retrospectively enrolled 4854 consecutive patients undergoing isolated CABG from February 2018 to September 2019, they were divided into derivation cohort and validation cohort with a 3:1 ratio according to the order of operation date. In the derivation cohort, significant variables were selected by use of the multivariate logistic backward stepwise regression analysis and a nomogram model was built on the strength of the results. The model performance was assessed in terms of discrimination and calibration. Besides, we compared the discriminative ability for POAF of the nomogram with established prediction models (CHA2DS2-VASc and HATCH scores) in the two cohorts. Results POAF occurred in 1025 (28.2%) out of 3641 patients in the derivation cohort, and in 337 (27.8%) out of 1213 patients in the validation cohort. A nomogram, composed of eight prognostic variables, namely age, sex, heart rate, hypertension, left ventricular ejection fraction (LVEF) <50%, left atrial diameter (LAD) > 40mm, estimated glomerular filtration rate (eGFR) level, and on-pump surgery, was constructed from the derivation cohort. The nomogram had substantial discriminative ability in derivation and validation cohorts with the area under the receiver operating characteristic curves (AUCs) of 0.661 (95% confidence interval, 0.642–0.681) and 0.665 (95% confidence interval, 0.631–0.699), respectively, and showed well-fitted calibration curves. Compared with CHA2DS2-VASc, HATCH and POAF scores, respectively, the nomogram had superior discrimination performance. Conclusion We constructed a novel nomogram with improved accuracy for predicting the risk of POAF following isolated CABG, which might help clinicians predict individual probability of POAF and achieve effective prophylaxis.
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Affiliation(s)
- Kangjun Fan
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People’s Republic of China
| | - Liang Chen
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People’s Republic of China
| | - Fei Liu
- Department of Biology, Faculty of Science, Hong Kong Baptist College, Kowloon Tong, Hong Kong, People’s Republic of China
| | - Xiaohang Ding
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People’s Republic of China
| | - Pengyun Yan
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People’s Republic of China
| | - Mingxin Gao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People’s Republic of China
| | - Wenyuan Yu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People’s Republic of China
| | - Hongli Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People’s Republic of China
| | - Yang Yu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People’s Republic of China
- Correspondence: Yang Yu, Tel +86-10-64456868, Fax +86-10-84005030, Email
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