Atrial fibrillation after cardiac surgery: to screen or not to screen?
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ABSTRACT:
SUBMITTER: Casadei B
PROVIDER: S-EPMC7820854 | biostudies-literature | 2021 Jan
REPOSITORIES: biostudies-literature
Publications
Atrial fibrillation after cardiac surgery: to screen or not to screen?
Casadei Barbara B Wijesurendra Rohan R
Cardiovascular research 20210101 2
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Project description: Not available
| S-EPMC5046840 | biostudies-literature
Project description:Despite having fewer risk factors for atrial fibrillation (AF), white patients have a greater prevalence of AF in the community than black patients, and a genetic basis has been postulated. However, it is unknown whether occurrence of new-onset AF after cardiac surgery is different in white versus black patients, and secondarily, other non-Caucasian patients.From 1995 through 2005, 20 282 white, 1323 black, and 1919 other non-Caucasian patients in sinus rhythm underwent coronary artery bypass grafting with or without valve surgery. To adjust for clinical and socioeconomic confounders, we performed propensity-adjusted analyses; 7093 white patients (35%) had postoperative AF, compared with 255 (22%) black patients and 550 (29%) other non-Caucasians (P<0.0001). Whites were older than black patients, had higher socioeconomic position, and greater left atrial size but were less likely to have hypertension or congestive heart failure. In 847 propensity-matched patient pairs, postoperative AF occurred more frequently in white than in black patients (odds ratio, 1.74; 95% confidence interval, 1.7-1.78). Other than higher occurrence of bradycardia requiring pacing and reintubation in white patients, occurrence of other postoperative complications, hospital mortality, and length of postoperative stay were similar. Age and valvular surgery were the strongest predictors of AF irrespective of race.White patients had a markedly higher risk of postoperative AF than black and other non-Caucasian patients. The cause for racial differences of arrhythmic risk is unknown, but a genetic predisposition is plausible. Our results have implications for risk stratification and mechanistic understanding of postoperative AF.
| S-EPMC3201706 | biostudies-literature
Project description: Not available
| S-EPMC10894399 | biostudies-literature
Project description:BackgroundAtrial fibrillation (AF) after cardiac surgery is a common marker of poor outcomes. Quantitative electrocardiographic (ECG) measurements may be valuable predictors of postoperative AF.MethodsWe evaluated clinical and ECG predictors of postoperative AF in 13,356 patients who underwent cardiac surgery in sinus rhythm.ResultsA total of 4724 patients (35%) developed postoperative AF. P-wave amplitude in leads aVR and V(1) were the strongest ECG predictors. A less negative P-wave amplitude in lead aVR was associated with increased risk for postoperative AF (odds ratio, 1.46; 95% confidence interval, 1.32-1.61), as was a more positive or a more negative P-wave amplitude in lead V(1) (odds ratio, 1.25; 95% confidence interval, 1.16-1.36) after adjusting for clinical and procedural predictors of postoperative AF. Reclassification analysis showed a 7% discrimination improvement (P < .0001).ConclusionsP-wave amplitude in lead aVR and lead V(1) are powerful predictors of postoperative AF and, in combination with other clinical predictors, can guide application of prophylactic interventions.
| S-EPMC3096700 | biostudies-literature
Project description:BackgroundAtrial fibrillation (Afib) is a marker of increased cardiovascular morbidity and mortality. Owing to the increased prevalence of Afib in patients undergoing cardiac surgery, assessing the effect of Afib on postsurgical outcomes is important. We aimed to analyze the effect of preoperative Afib on clinical outcomes in patients undergoing cardiac surgery using a large surgical database.MethodsThis retrospective cohort study was based on the national health claims database established by the National Health Insurance Service of the Republic of Korea from 2009 to 2015. Diagnosis and procedure codes were used to identify diseases according to the International Statistical Classification of Diseases, 10th revision.ResultsWe included 1,037 patients (0.1%) who had undergone cardiac surgery from a randomized 1,000,000-patient cohort, and 15 patients (1.5%) treated with isolated surgical Afib ablation were excluded. Of these 1,022 patients, 412 (39.7%), 303 (29.2%), and 92 (9.0%) underwent coronary artery bypass, heart valve surgery, and Cox-maze surgery, respectively. Preoperative Afib was associated with higher patient mortality (p=0.028), regardless of the surgical procedure. Patients with preoperative Afib (n=190, 18.6%) experienced a higher cumulative risk of overall mortality (hazard ratio [HR], 1.435; 95% confidence interval [CI], 1.263-2.107; p=0.034). Subgroup analysis revealed a reduced risk of overall mortality with Cox-maze surgery in Afib patients (HR, 0.500; 95% CI, 0.266-0.938; p=0.031). Postoperative cerebral ischemia or hemorrhage events were not related to Afib.ConclusionPreoperative Afib was independently associated with worse long-term postoperative outcomes after cardiac surgery. Concomitant Cox-maze surgery may improve the survival rate.
| S-EPMC9579845 | biostudies-literature
Project description:ImportanceThere are limited data on the association of sex with the incidence of postoperative atrial fibrillation (poAF) and subsequent long-term mortality after cardiac surgery.ObjectiveTo evaluate whether the incidence of poAF and associated long-term mortality after cardiac surgery differ by sex.Design, setting, and participantsThis retrospective cohort study was conducted at 2 tertiary care centers in Massachusetts from January 1, 2002, until October 1, 2016, with follow-up until December 1, 2022. Adult (aged >20 years) women and men undergoing coronary artery bypass graft surgery, aortic valve surgery, mitral valve surgery, and combined procedures with cardiopulmonary bypass were examined using medical records. Patients who had data on poAF were included in data analyses.ExposuresSex and poAF.Main outcomes and measuresPrimary outcomes were the incidence of poAF and all-cause mortality. poAF was defined as any atrial fibrillation detected on electrocardiogram (EKG) during the index hospitalization in patients presenting for surgery in normal sinus rhythm. Data on poAF were obtained from EKG reports and supplemented by information from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. All-cause mortality was assessed via hospital records. The hypotheses were formulated prior to data analysis.ResultsAmong 21 568 patients with poAF data (mean [SD] age, 66.5 [12.4] years), 2694 of 6601 women (40.8%) and 5805 of 14 967 men (38.8%) developed poAF. In a multivariable logistic regression model, women had lower risk of poAF (odds ratio [OR], 0.85; 95% CI, 0.79-0.91; P < .001). During the follow-up study period, 1294 women (50.4%) and 2376 men (48.9%) in the poAF group as well as 1273 women (49.6%) and 2484 men (51.1%) in the non-poAF group died. Cox proportional hazards analysis found that the association between poAF and mortality was significantly moderated (ie, effect modified) by sex. Compared with same-sex individuals without poAF, men with poAF had a 17% higher mortality hazard (hazard ratio [HR], 1.17; 95% CI, 1.11-1.25; P < .001), and women with poAF had a 31% higher mortality hazard (HR, 1.31; 95% CI, 1.21-1.42; P < .001).Conclusions and relevanceIn this retrospective cohort study of 21 568 patients who underwent cardiac surgery, women were less likely to develop poAF than men when controlling for other relevant characteristics; however, women who did develop poAF had a higher risk of long-term mortality than men who developed poAF. This observed elevated risk calls for a tailored approach to perioperative care in women undergoing cardiac surgery.
| S-EPMC11339658 | biostudies-literature
Project description:Postoperative atrial fibrillation (POAF) after cardiac surgery is associated with elevated morbidity and mortality. Although current prediction models have limited efficacy, several perioperative interventions can reduce patients' risk of POAF. These begin with preoperative medications, including beta-blockers and amiodarone. Moreover, patients should be screened for preexisting atrial fibrillation (AF) so that concomitant surgical ablation and left atrial appendage occlusion can be performed in appropriate candidates. Intraoperative interventions such as posterior pericardiectomy can reduce mediastinal fluid accumulation, which is a trigger for POAF. Furthermore, many preventive strategies for POAF are implemented in the immediate postoperative period. Initiating beta-blockers, amiodarone, or both is reasonable for most patients. Overdrive atrial pacing, colchicine, and steroids have been used by some, although the evidence base is less robust. For patients with POAF, rate-control and rhythm-control strategies have comparable outcomes. Decision-making regarding anticoagulation should recognize that the stroke risk associated with POAF appears to be lower than that for general nonvalvular AF. The evidence that oral anticoagulation reduces stroke risk is less clear for POAF patients than for patients with general nonvalvular AF. Given that POAF tends to be shorter-lived and is associated with greater bleeding risks in the perioperative period, decisions regarding anticoagulation should be individualized. Finally, wearable technology and machine learning algorithms for better predicting and managing POAF appear to be coming soon. These technologies and a comprehensive clinical program could meaningfully reduce the incidence of this common complication.
| S-EPMC10944787 | biostudies-literature
Project description:Background: Post cardiac surgery atrial fibrillation is common after cardiac surgery. Despite the advances in medical and surgical treatment, its incidence remains high and unchanged for decades. The aim of this review was to summarize studies published in 2011 on identifying factors, prevention strategies, treatment and effect of post operative atrial fibrillation (POAF) on the outcome after cardiac surgery. Methods: A review was performed on Medline, Embase and Chocrane on all of the English-language, peer-reviewed published clinical studies on POAF; studies investigating the mechanism of developing POAF, prevention, treatment and outcome were all included and analyzed. Case reports, studies on persistent/preoperative atrial fibrillation (AF), POAF after cardiac transplant, congenital cases and nonclinical studies were all excluded. We have also valuated these studies based on the type of the study, their originality, impact factor of the journal and their limitations. Results: Overall 62 studies were reviewed and analyzed; 26 on POAF predictive factors, 31 on preventative strategies and 6 on the outcome of POAF. Of these studies only two were original and the remaining were either performed in AF in general population (n=10) or had been studied and reported several times before in cardiac surgery (n=50). The average impact factor of the journals that POAF was published in was only 2.8 ranging between 0.5 and 14.5. Conclusion: Post cardiac surgery atrial fibrillation is a multi-factorial and complex condition. Cardiac surgery may be a risk factor for developing POAF in patients already susceptible to this condition and may not be a complication of cardiac surgery. Future studies should mainly focus on histological changes in the conductive tissue of atrium and related treatment strategies rather than predictive factors of POAF and more funding should be made available to study this condition from new and entirely different perspectives.
| S-EPMC5153217 | biostudies-literature
Project description:BackgroundA meta-analysis study was conducted to determine how to predict the effect of postoperative atrial fibrillation after cardiac surgery.HypothesisLong-term mortality and cardiovascular morbidity are linked to postoperative atrial fibrillation.MethodUntil August 2024, a comprehensive literature study was completed, and 3486 connected studies were revised. The 38 selected studies included 241 299 cardiac surgery participants at the beginning of the study. The odds ratio (OR) and 95% confidence intervals (CIs) were used to look at the effect of atrial fibrillation after heart surgery using two-sided methods and either a fixed or random model.ResultsIndividuals with cardiac surgery with postoperative atrial fibrillation had significantly higher mortality at 1 year (OR, 1.39; 95% CI, 1.12-1.72, p < 0.001), mortality at 5 years (OR, 1.61; 95% CI, 1.33-1.94, p < 0.001), mortality at 10 years (OR, 1.61; 95% CI, 1.39-1.87, p < 0.001), and overall stroke (OR, 1.61; 95% CI, 1.34-1.94, p < 0.001) compared to without postoperative atrial fibrillation.ConclusionsIndividuals with cardiac surgery with postoperative atrial fibrillation had significantly higher mortality at 1 year, mortality at 5 years, mortality at 10 years, and overall stroke compared to those without postoperative atrial fibrillation. To validate this discovery, more research and caution must be implemented when interacting with its values.
| S-EPMC11617639 | biostudies-literature
Project description:BackgroundAtrial fibrillation after cardiac surgery is associated with increased rates of death, complications, and hospitalizations. In patients with postoperative atrial fibrillation who are in stable condition, the best initial treatment strategy--heart-rate control or rhythm control--remains controversial.MethodsPatients with new-onset postoperative atrial fibrillation were randomly assigned to undergo either rate control or rhythm control. The primary end point was the total number of days of hospitalization within 60 days after randomization, as assessed by the Wilcoxon rank-sum test.ResultsPostoperative atrial fibrillation occurred in 695 of the 2109 patients (33.0%) who were enrolled preoperatively; of these patients, 523 underwent randomization. The total numbers of hospital days in the rate-control group and the rhythm-control group were similar (median, 5.1 days and 5.0 days, respectively; P=0.76). There were no significant between-group differences in the rates of death (P=0.64) or overall serious adverse events (24.8 per 100 patient-months in the rate-control group and 26.4 per 100 patient-months in the rhythm-control group, P=0.61), including thromboembolic and bleeding events. About 25% of the patients in each group deviated from the assigned therapy, mainly because of drug ineffectiveness (in the rate-control group) or amiodarone side effects or adverse drug reactions (in the rhythm-control group). At 60 days, 93.8% of the patients in the rate-control group and 97.9% of those in the rhythm-control group had had a stable heart rhythm without atrial fibrillation for the previous 30 days (P=0.02), and 84.2% and 86.9%, respectively, had been free from atrial fibrillation from discharge to 60 days (P=0.41).ConclusionsStrategies for rate control and rhythm control to treat postoperative atrial fibrillation were associated with equal numbers of days of hospitalization, similar complication rates, and similarly low rates of persistent atrial fibrillation 60 days after onset. Neither treatment strategy showed a net clinical advantage over the other. (Funded by the National Institutes of Health and the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT02132767.).
| S-EPMC4908812 | biostudies-literature