Predictors of post-operative atrial fibrillation in patients undergoing isolated coronary artery bypass grafting

Clinical characteristics and prognostic implication of atrial fibrillation in the postoperative period of cardiac surgery with cardiopulmonary bypass

INTRODUCTION

Despite the latest innovations in surgical and cardiopulmonary bypass techniques, atrial fibrillation remains a common occurrence in patients undergoing heart surgery, and has been shown to increase the incidence of intra- and postoperative complications. For this reason, it is among the top 10 research topics in cardiovascular surgery.

METHOD

Observational, analytical, retrospective study carried out at the largest cardiovascular centre in Mexico. Adult patients (>18 years) with no history of atrial fibrillation who underwent on-pump heart surgery between 1 January 2022 and 31 December 2023 were included. Variables that have previously been correlated with postoperative atrial fibrillation (POAF) were evaluated.

RESULTS

A total of 544 patients were included. The incidence of POAF was 23.8%. Overall in-hospital mortality was 5.9%. There was a significant difference in age between patients that developed postoperative atrial fibrillation and those that maintained sinus rhythm (62 years vs 57 years, p = < 0.01). Using a univariate logistic regression model, we found that POAF significantly predicts the occurrence of hospital-acquired pneumonia (OR 3.12, 95% CI 1.61-6.02, p = <0.01) and the requirement for renal replacement therapy (OR 3.04, 95% CI 1.34-6.86, p = <0.01).

CONCLUSIONS

Atrial fibrillation is a common arrhythmia in the postoperative period of on-pump heart surgery, and is a predictor of adverse outcomes. Prevention, early detection and treatment of POAF may have prognostic implications.

Risk Factors of Postoperative Atrial Fibrillation After Isolated Coronary Artery Bypass Grafting Surgery in the Recent 10 Years: Clinical Analysis of 6229 Patients

BACKGROUND

Postoperative atrial fibrillation (POAF) is a common complication after coronary artery bypass grafting (CABG) that prolongs hospitalization and increases expenses.

HYPOTHESIS

Perioperative risk factors may predict POAF.

METHODS

From March 2015 to January 2023, 6229 patients who underwent isolated CABG and were in sinus rhythm before CABG were included in this retrospective study. The preoperative and postoperative variants of patients were collected and analyzed by univariate analyses between the patients with and without POAF. Multivariate logistic regression analysis was then used to study the independent risk factors for POAF.

RESULTS

The incidence of POAF in this group of patients was 30.94%. Univariate analyses demonstrated that age (p < 0.001), hypertension (p < 0.001), smoking (p < 0.05), cardiopulmonary bypass (CPB) time (p < 0.01), and ejection fraction (EF, p < 0.01) were the risk factors for POAF. Multivariate logistic regression analysis determined the independent risk factors associated with POAF were old age (odds ratio [OR] = 1.062, p = 0.000) and low EF (OR = 0.980; p = 0.008).

CONCLUSIONS

In the current era, after isolated CABG surgery, there is still a quite high incidence of POAF (30.94% in this group of CABG patients). The main risk factors correlating to POAF include age, hypertension, smoking, CPB time, and EF. Among these factors, multivariate analysis identified old age and low EF as the independent risk factors associated with POAF. Particular care should be taken in the perioperative period for these patients in the prevention of POAF.

Incidence and predictors of post-surgery atrial fibrillation occurrence: A cohort study in 53,387 patients

Introduction

Atrial fibrillation (AF) represents the most common arrhythmia in the postoperative setting. We aimed to investigate the incidence of postoperative AF (POAF) and determine its predictors, with a specific focus on inflammation markers.

Methods

We performed a retrospective single tertiary center cohort study including consecutive adult patients who underwent a major surgical procedure between January 2016 and January 2020. Patients were divided into four subgroups according to the type of surgery.

Results

Among 53,387 included patients (79.4% male, age 64.5 ± 9.5 years), POAF occurred in 570 (1.1%) with a mean latency after surgery of 3.4 ± 2.6 days. Ninety patients died (0.17%) after a mean of 13.7 ± 8.4 days. The 28-day arrhythmia-free survival was lower in patients undergoing lung and cardiovascular surgery (p < .001). Patients who developed POAF had higher levels of C-reactive protein (CRP) (0.70 ± 0.03 vs. 0.40 ± 0.01 log10 mg/dl; p < .001). In the multivariable Cox regression analysis, adjusting for confounding factors, CRP was an independent predictor of POAF [HR per 1 mg/dL increase in log-scale = 1.81 (95% CI 1.18-2.79); p = .007]. Moreover, independent predictors of POAF were also age (HR/1 year increase = 1.06 (95% CI 1.04-1.08); I < .001), lung and cardiovascular surgery (HR 23.62; (95% CI 5.65-98.73); p < .001), and abdominal and esophageal surgery (HR 6.26; 95% CI 1.48-26.49; p = .013).

Conclusions

Lung and cardiovascular surgery had the highest risk of POAF in the presented cohort. CRP was an independent predictor of POAF and postsurgery inflammation may represent a major driver in the pathophysiology of the arrhythmia.

Predicting atrial fibrillation after cardiac surgery: a scoping review of associated factors and systematic review of existing prediction models

INTRODUCTION

Postoperative atrial fibrillation (POAF) is common after cardiac surgery and associated with increased hospital length of stay, patient morbidity and mortality. We aimed to identify factors associated with POAF and evaluate the accuracy of available POAF prediction models.

METHODS

We screened articles from Ovid MEDLINE® and PubMed Central® (PMC) and included studies that evaluated risk factors associated with POAF or studies that designed or validated POAF prediction models. We only included studies in cardiac surgical patients with sample size n ⩾ 50 and a POAF outcome group ⩾20. We summarised factors that were associated with POAF and assessed prediction model performance by reviewing reported calibration and discriminative ability.

RESULTS

We reviewed 232 studies. Of these, 142 fulfilled the inclusion criteria. Age was frequently found to be associated with POAF, while most other variables showed contradictory findings, or were assessed in few studies. Overall, 15 studies specifically developed and/or validated 12 prediction models. Of these, all showed poor discrimination or absent calibration in predicting POAF in externally validated cohorts.

CONCLUSIONS

Except for age, reporting of factors associated with POAF is inconsistent and often contradictory. Prediction models have low discrimination, missing calibration statistics, are at risk of bias and show limited clinical applicability. This suggests the need for studies that prospectively collect AF relevant data in large cohorts and then proceed to validate findings in external data sets.

Utility of the CHA2DS2-VASc Score in Prediction of Postoperative Atrial Fibrillation After Coronary Artery Bypass Graft Surgery

OBJECTIVE

The authors aimed to investigate the role of CHA₂DS₂-VASc score and its components in prediction of postoperative atrial fibrillation (POAF) after isolated coronary artery bypass graft (CABG) surgery.

DESIGN

Retrospective cohort.

SETTING

Single-center university-affiliated tertiary cardiac center.

PARTICIPANTS

A total of 2,981 consecutive patients who underwent isolated CABG between 2010 and 2012 were included.

INTERVENTIONS

All patients underwent isolated CABG and were followed until discharge or in-hospital death. The primary outcome was the development of new-onset POAF during the hospital course.

MEASUREMENTS AND MAIN RESULTS

During hospitalization, continuous electrocardiogram monitoring was used to detect POAF episodes. New-onset POAF developed in 15.8% of patients following isolated CABG. Patients with POAF had significantly higher CHA₂DS₂-VASc scores than those without POAF (2.66 ± 1.51 v 2.12 ± 1.36, p < 0.001). After adjustment for potential confounders, CHA₂DS₂-VASc score was significantly associated with POAF (odds ratio [OR]: 1.295, 95% CI: 1.205-1.391). However, further analyses showed that this effect was restricted to patients with a CHA₂DS₂-VASc score of ≥2 (OR: 1.813, 95% CI: 1.220-2.694). In multivariate analysis of the CHA₂DS₂-VASc components, age ≥75 (OR: 3.737, 95% CI: 2.702-5.168), age 65 to 74 (OR: 2.126, 1.701-2.658), hypertension (OR: 1.310, 95% CI: 1.051-1.633), and cerebrovascular accident (OR: 1.807, 95% CI: 1.197-2.726) were independent predictors of POAF. However, the association between POAF and female sex, diabetes mellitus, congestive heart failure, and vascular disease was not statistically significant.

CONCLUSIONS

CHA₂DS₂-VASc score is a useful tool for the prediction of POAF after isolated CABG. However, the risk should be interpreted cautiously, since the risk score's promising effect relies on only several of its components.

Impact of Minimally Invasive Esophagectomy in Post-Operative Atrial Fibrillation and Long-Term Mortality in Patients Among Esophageal Cancer

Aims:

Postoperative Atrial fibrillation (POAF) after esophagectomy may prolong stay in intensive care and increase risk of perioperative complications. A minimally invasive approach is becoming the preferred option for esophagectomy, yet its implications for POAF risk remains unclear. The association between POAF and minimally invasive esophagectomy (MIE) was examined in this study.

Methods:

We used a dataset of 575 patients who underwent esophagectomy. Multivariate logistic regression analysis was performed to examine the association between MIE and POAF. A cox proportional hazards model was applied to assess the long-term mortality (MIE vs open esophagectomy, OE).

Results:

Of the 575 patients with esophageal cancer, 62 developed POAF. MIE was negatively associated with the occurrence of POAF (Odds ratio: 0.163, 95%CI: 0.033-0.801). No significant difference was observed in long-term mortality (Odds ratio: 2.144, 95%CI: 0.963-4.775).

Conclusions:

MIE may reduced the incidence of POAF without compromising the survival of patients with esophageal cancer. Moreover, the specific mechanism of MIE providing this possible advantage needs to be determined by larger prospective cohort studies with specific biomarker information from laboratory tests.

Biochemical predictors of postoperative atrial fibrillation following cardiac surgery

Background

New-onset postoperative atrial fibrillation (POAF) is common after cardiac surgery. Early identification of its risk factors during the preoperative period would help in reducing the associated morbidity, mortality, and healthcare costs.

Aim of the study

This study aimed to identify the predictors of POAF following open cardiac surgery, with emphasis on biochemical parameters.

Methods

A total of 1191 patients with no preoperative atrial fibrillation (AF) and undergoing open cardiac surgery for any reason were included in this retrospective study. Data on clinical and biochemical parameters, the occurrence of new-onset AF, and its clinical course were retrieved from the hospital database.

Results

During the early postoperative period 330 patients (27.7%) developed atrial fibrillation, at median third postoperative day (range 1–6 days) and 217 (65.8%) responded to treatment. Multivariate analysis identified the following as the significant independent predictors of any POAF: EF < 60% (Odds ratio (OR), 2.6), valvular intervention (OR, 2.4), liver failure (OR, 2.4), diabetes (OR, 1.6), low hematocrit (OR, 2.1), low thrombocyte (OR, 5.6), low LDL (OR, 1.6), high direct bilirubin (OR, 2.0), low GFR (OR, 1.6), and high CRP (OR, 2.0). Following parameters emerged as significant independent predictors of persistent AF: EF < 60% (OR, 1.9), diabetes (OR, 2.1), COPD (OR, 1.8), previous cardiac surgery (OR, 3.1), valvular intervention (OR, 2.4), low hematocrit (OR, 1.9), low LDL (OR, 2.1), high HbA1c (OR, 2.0), and high CRP (OR, 2.7).

Conclusions

Certain parameters assessed during preoperative physical and laboratory examinations have the potential to be used as markers of POAF.

Atrial fibrillation - Can HbA1c levels really predict the risk?

BACKGROUND

Diabetes is associated with higher mortality and worse post-operative outcomes in patients undergoing coronary artery bypass grafting and HbA1c levels have consistently been reported to be associated with adverse post-operative outcomes. However, the role of HbA1c still remains unclear with regards to the occurrence of atrial fibrillation.

METHOD

Data for the patients undergoing off-pump coronary artery bypass grafting was analysed in a retrospective fashion. Patients were divided into-those with HbA1c < 6.5% and those with HbA1c ≥ 6.5% and the incidence of atrial fibrillation observed in these two groups. We also compared patient who developed atrial fibrillation in the post-operative period and compared them with those who did not.

RESULTS

Of the 5259 patients included in the study HbA1c was <6.5 in 2808 (53.4%) patients and was ≥6.5 in 2451 (46.6%) patients; 623 (11.8%) patients in our study developed atrial fibrillation. Onset of atrial fibrillation in the post-operative period was seen most commonly 235 (38.3%) on between 24 and 48 h after the operation with more than half of them 338 (54.2%) occurring within the first 48 h. On multivariate analysis, HbA1c was not a risk factor for atrial fibrillation (odd's ratio 1.144, 95% confidence interval 0.967-1.354). Only increased age (odd's ratio 1.08; 95% confidence interval 1.069-1.091); EuroSCORE (odd's ratio 1.073; 95% confidence interval 1.048-1.099); history of recent MI (odd's ratio 0.768; 95% confidence interval 0.606-0.971) and peripheral vascular disease (odd's ratio 1.667; 95% confidence interval 1.091-2.517) were found to be independently associated with increased risk of atrial fibrillation in the post-operative period.

CONCLUSIONS

After adjusting for confounders HbA1c levels do not independently predict risk of atrial fibrillation after off-pump coronary artery bypass grafting.

Overweight and aging increase the risk of atrial fibrillation after cardiac surgery independently of left atrial size and left ventricular ejection fraction

BACKGROUND

Body mass index (BMI), age, left atrium (LA) dimension and left ventricular ejection fraction (LVEF) have been linked to post-operative atrial fibrillation (POAF) after cardiac surgery. The aim of this study was to better define the role of these risk factors.

METHODS

This retrospective cohort study evaluated 249 patients (without prior atrial dysrhythmia) undergoing cardiac or aortic surgery. Prior to surgery, the following data were collected: age, BMI, LA diameter, LA area, LVEF, thyroid stimulating hormone (TSH), creatinine and the presence of arterial hypertension (AH) and diabetes. Intraoperative data such as operation time, total clamp time, cardiopulmonary bypass time, and presence of pericardial/pleural effusion were also collected. Only patients without pre- and post-surgery prophylactic anti-arrhythmic therapy were included.

RESULTS

Patients with (N = 127, 51%) and without POAF (N = 122, 49%) were compared. No difference was observed for sex, LA diameter, LA area, LVEF, TSH, diabetes and use of ACE inhibitors or statins prior to intervention. Moreover, no difference was observed in terms of operation time, total clamp time, cardiopulmonary bypass time, and presence of pericardial/pleural effusion. However, patients with POAF were older (70.6 ± 10.7 vs. 60.4 ± 16.4 years, p = 0.001), had higher BMI (26.8 ± 4.5 vs. 24.9 ± 3.6 kg/m2, p = 0.001), higher baseline creatinine (1.06 ± 0.91 vs. 0.88 ± 0.32 mg/dL, p = 0.038) and a higher frequency of arterial hypertension (73.2% vs. 50%, p = 0.001) and Bentall procedure (24.4% vs. 9.8%, p = 0.023). Multivariate analysis showed that the only independent predictors of POAF were age (OR = 1.05, 95%CI 1.02-1.07, p = 0.001) and BMI (OR = 1.11 95%CI 1.03-1.2,p = 0.006).

CONCLUSIONS

These findings suggest that advanced age and a higher BMI are strong risk factors for POAF in patients without previous AF even in the presence of comparable LA dimensions and LVEF.

The role of surgery type in postoperative atrial fibrillation and in-hospital mortality in esophageal cancer patients with preserved left ventricular ejection fraction

BACKGROUND

Postoperative atrial fibrillation (POAF) is one of the most common complications of esophagectomy, which may extend the inpatient hospital stay. Minimally invasive esophagectomy (MIE) has been increasingly used in clinical practice; however, its POAF risk and short-term mortality remain unclear. This study aimed to examine the POAF risk and in-hospital mortality rate between patients receiving MIE and open esophagectomy (OE).

METHODS

Esophageal cancer patients who underwent MIE or OE from a retrospective cohort study were evaluated. A multivariate logistic regression model was built to assess the associations between esophagectomy (MIE vs. OE) and various outcomes (POAF, in-hospital mortality). Covariates included age, sex, body mass index, neoadjuvant therapy, tumor stage, surgery incision type, comorbidities, cardia conditions, peri-operative medication, and complications.

RESULTS

Of the 484 patients with esophageal cancer, 63 received MIE. A total of 53 patients developed POAF. Compared to patients receiving OE, MIE patients had 81% reduced odds of POAF (adjusted odds ratio [aOR] 0.185, 95% CI 0.039-0.887, P = 0.035). No statistically significant association was found for in-hospital mortality (aOR 0.709, 95% CI 0.114-4.409, P = 0.712).

CONCLUSIONS

MIE is associated with a lower risk of POAF, compared to traditional surgery. No significant short-term survival benefit was found for MIE.

Postoperative complications associated with coronary artery bypass graft surgery and their therapeutic interventions

Coronary artery disease is one of the commonest surgery demanding cardiovascular diseases. Coronary artery bypass graft surgery is practiced all over the world for the treatment of coronary artery disease. Systemic trauma during the surgery is associated with a wide range of complications, some of which are fatal. Preoperative risk factors such as age, previous illness and obesity are common predictors of these adverse events. Advances in therapeutic medicine have allowed timely treatment of these adverse events and co-morbidities. This review summarizes some of the most occurring complications associated with coronary artery bypass graft and corresponding treatment options.

Predictors Affecting Postoperative Atrial Fibrillation in Patients After Coronary Artery Bypass Graft

The aim of this study is to investigate the differences in POAF (postoperative atrial fibrillation) and non-POAF patients using demographic and clinical characteristics and identify predictors affecting POAF after coronary artery bypass grafts in South Korea. This retrospective cohort study included 999 patients followed-up for at least 1 year after coronary artery bypass graft, between January 2011 and December 2015. Multivariate logistic regression was performed to assess risk factors based on demographics, as well as preoperative and postoperative characteristics. The adjusted multivariate analysis demonstrated that risk factors for POAF were old age (⩾65 years; odds ratio [OR] = 3.022, p < .001), ejection fraction less than 45% (OR = 1.489, p = .036), electrolyte potassium level after surgery (OR = 1.765, p = .003), and the average pain score on Postoperative Day 1 (OR = 1.253, p < .001). The incidence of atrial fibrillation after coronary artery bypass graft surgery can be reduced through the screening of preoperative risk factors, strict potassium monitoring, and pain management strategies.