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Thorac Cardiovasc Surg 2019; 67(02): 107-116
DOI: 10.1055/s-0038-1667065
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Clinical Risk Factors for Postoperative Atrial Fibrillation among Patients after Cardiac Surgery

Kennosuke Yamashita   *
1   Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, United States
2   Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States
,
Nan Hu   *
3   Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States
4   Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States
,
Ravi Ranjan
1   Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, United States
2   Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States
,
Craig H. Selzman
1   Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, United States
5   Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, United States
,
Derek J. Dosdall
1   Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, United States
2   Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States
5   Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, United States
› Author Affiliations
Further Information

Publication History

12 April 2018

07 June 2018

Publication Date:
02 August 2018 (online)

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Abstract

Background Postoperative atrial fibrillation (POAF) is a common arrhythmia following cardiac surgery and is associated with increased health-care costs, complications, and mortality. The etiology of POAF is incompletely understood and its prediction remains suboptimal. Using data from published studies, we performed a systemic review and meta-analysis to identify preoperative clinical risk factors associated with patients at increased risk of POAF.

Methods A systematic search of PubMed, MEDLINE, and EMBASE databases was performed.

Results Twenty-four studies that reported univariate analysis results regarding POAF risk factors, published from 2001 to May 2017, were included in this meta-analysis with a total number of 36,834 subjects. Eighteen studies were performed in the United States and Europe and 16 studies were prospective cohort studies. The standardized mean difference (SMD) between POAF and non-POAF groups was significantly different (reported as [SMD: 95% confidence interval, CI]) for age (0.55: 0.47–0.63), left atrial diameter (0.45: 0.15–0.75), and left ventricular ejection fraction (0.30: 0.14–0.47). The pooled odds ratios (ORs) (reported as [OR: 95% CI]) demonstrated that heart failure (1.56: 1.31–1.96), chronic obstructive pulmonary disease (1.36: 1.13–1.64), hypertension (1.29: 1.12–1.48), and myocardial infarction (1.18: 1.05–1.34) were significant predictors of POAF incidence, while diabetes was marginally significant (1.06: 1.00–1.13).

Conclusion The present analysis suggested that older age and history of heart failure were significant risk factors for POAF consistently whether the included studies were prospective or retrospective datasets.

Keywords

atrial fibrillation - cardiac surgery - odds ratios - standardized mean difference

Note

This paper has been presented at the American College of Cariology's 67th Annual Scientific Session & Expo in Orlando, taking place from March 10th to 12th. Journal of the American College of Cardiology, Volume 71, Issue 11, Supplement, 10–12 March 2018, Page a371.


Author Contributions

(1) KY, NH, and DD devised the study design and conception. KY, NH, and DD analyzed and interpreted data.


(2) KY, NH, and DD drafted the manuscript and CC, RR, NH, and DD revised it critically.


(3) All authors approved the final version of the manuscript.


* Both authors contributed equally to the manuscript.


 

  • References

  • 1 Abdel-Massih TE, Sarkis A, Sleilaty G. , et al. Myocardial extraction of intracellular magnesium and atrial fibrillation after coronary surgery. Int J Cardiol 2012; 160 (02) 114-118
    CrossrefPubMedGoogle Scholar
  • 2 Anderson EJ, Efird JT, Kiser AC. , et al. Plasma catecholamine levels on the morning of surgery predict post-operative atrial fibrillation. JACC Clin Electrophysiol 2017; 3 (12) 1456-1465
    PubMedGoogle Scholar
  • 3 Antoniades C, Van-Assche T, Shirodaria C. , et al. Preoperative sCD40L levels predict risk of atrial fibrillation after off-pump coronary artery bypass graft surgery. Circulation 2009; 120 (11, Suppl): S170-S176
    CrossrefPubMedGoogle Scholar
  • 4 Başaran Ö, Tigen K, Gözübüyük G. , et al. Predictive role of left atrial and ventricular mechanical function in postoperative atrial fibrillation: a two-dimensional speckle-tracking echocardiography study. Turk Kardiyol Dern Ars 2016; 44 (01) 45-52
    PubMedGoogle Scholar
  • 5 Bolesta S, Kong F. Effect of statins on the incidence of postoperative atrial fibrillation after cardiac valve surgery. Pharmacotherapy 2015; 35 (11) 998-1006
    CrossrefPubMedGoogle Scholar
  • 6 Bouchot O, Guenancia C, Kahli A. , et al. Low circulating levels of growth differentiation factor-15 before coronary artery bypass surgery may predict postoperative atrial fibrillation. J Cardiothorac Vasc Anesth 2015; 29 (05) 1131-1139
    CrossrefPubMedGoogle Scholar
  • 7 Budeus M, Hennersdorf M, Röhlen S. , et al. Prediction of atrial fibrillation after coronary artery bypass grafting: the role of chemoreflex-sensitivity and P wave signal averaged ECG. Int J Cardiol 2006; 106 (01) 67-74
    CrossrefPubMedGoogle Scholar
  • 8 Çetin M, Kocaman SA, Erdoğan T. , et al. Fragmented QRS may predict postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass graft surgery. Anadolu Kardiyol Derg 2012; 12 (07) 576-583
    PubMedGoogle Scholar
  • 9 Choi YS, Shim JK, Hong SW, Kim DH, Kim JC, Kwak YL. Risk factors of atrial fibrillation following off-pump coronary artery bypass graft surgery: predictive value of C-reactive protein and transfusion requirement. Eur J Cardiothorac Surg 2009; 36 (05) 838-843
    CrossrefPubMedGoogle Scholar
  • 10 Di Gioia G, Mega S, Nenna A. , et al. Should pre-operative left atrial volume receive more consideration in patients with degenerative mitral valve disease undergoing mitral valve surgery?. Int J Cardiol 2017; 227: 106-113
    CrossrefPubMedGoogle Scholar
  • 11 Dogan SM, Buyukates M, Kandemir O. , et al. Predictors of atrial fibrillation after coronary artery bypass surgery. Coron Artery Dis 2007; 18 (05) 327-331
    CrossrefPubMedGoogle Scholar
  • 12 El-Chami MF, Kilgo PD, Elfstrom KM. , et al. Prediction of new onset atrial fibrillation after cardiac revascularization surgery. Am J Cardiol 2012; 110 (05) 649-654
    CrossrefPubMedGoogle Scholar
  • 13 Gang Y, Hnatkova K, Mandal K, Ghuran A, Malik M. Preoperative electrocardiographic risk assessment of atrial fibrillation after coronary artery bypass grafting. J Cardiovasc Electrophysiol 2004; 15 (12) 1379-1386
    CrossrefPubMedGoogle Scholar
  • 14 Gode S, Aksu T, Demirel A. , et al. Effect of vitamin D deficiency on the development of postoperative atrial fibrillation in coronary artery bypass patients. J Cardiovasc Thorac Res 2016; 8 (04) 140-146
    CrossrefPubMedGoogle Scholar
  • 15 Guo Y, Wu X, Zheng X, Lu J, Wang S, Huang X. Usefulness of preoperative transforming growth factor-beta to predict new onset atrial fibrillation after surgical ventricular septal myectomy in patients with obstructive hypertrophic cardiomyopathy. Am J Cardiol 2017; 120 (01) 118-123
    CrossrefPubMedGoogle Scholar
  • 16 Hernández-Romero D, Vílchez JA, Lahoz Á. , et al. Galectin-3 as a marker of interstitial atrial remodelling involved in atrial fibrillation. Sci Rep 2017; 7: 40378
    CrossrefPubMedGoogle Scholar
  • 17 Ngai J, Leonard J, Echevarria G, Neuburger P, Applebaum R. Left atrial appendage velocity as a predictor of atrial fibrillation after cardiac surgery. J Cardiothorac Vasc Anesth 2016; 30 (02) 413-417
    CrossrefPubMedGoogle Scholar
  • 18 O'Neal WT, Efird JT, Davies SW. , et al. Impact of race and postoperative atrial fibrillation on long-term survival after coronary artery bypass grafting. J Card Surg 2013; 28 (05) 484-491
    CrossrefPubMedGoogle Scholar
  • 19 Osranek M, Fatema K, Qaddoura F. , et al. Left atrial volume predicts the risk of atrial fibrillation after cardiac surgery: a prospective study. J Am Coll Cardiol 2006; 48 (04) 779-786
    CrossrefPubMedGoogle Scholar
  • 20 Park SJ, On YK, Kim JS, Jeong DS, Kim WS, Lee YT. Heart rate turbulence for predicting new-onset atrial fibrillation in patients undergoing coronary artery bypass grafting. Int J Cardiol 2014; 174 (03) 579-585
    CrossrefPubMedGoogle Scholar
  • 21 Saskin H, Serhan Ozcan K, Yilmaz S. High preoperative monocyte count/high-density lipoprotein ratio is associated with postoperative atrial fibrillation and mortality in coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 2017; 24 (03) 395-401
    PubMedGoogle Scholar
  • 22 Shariff N, Zelenkofske S, Eid S, Weiss MJ, Mohammed MQ. Demographic determinants and effect of pre-operative angiotensin converting enzyme inhibitors and angiotensin receptor blockers on the occurrence of atrial fibrillation after CABG surgery. BMC Cardiovasc Disord 2010; 10: 7
    CrossrefPubMedGoogle Scholar
  • 23 Silva RG, Lima GG, Guerra N, Bigolin AV, Petersen LC. Risk index proposal to predict atrial fibrillation after cardiac surgery. Rev Bras Cir Cardiovasc 2010; 25 (02) 183-189
    CrossrefPubMedGoogle Scholar
  • 24 Takahashi S, Fujiwara M, Watadani K. , et al. Preoperative tissue Doppler imaging-derived atrial conduction time can predict postoperative atrial fibrillation in patients undergoing aortic valve replacement for aortic valve stenosis. Circ J 2014; 78 (09) 2173-2181
    CrossrefPubMedGoogle Scholar
  • 25 Ha AC, Mazer CD, Verma S, Yanagawa B, Verma A. Management of postoperative atrial fibrillation after cardiac surgery. Curr Opin Cardiol 2016; 31 (02) 183-190
    CrossrefPubMedGoogle Scholar
  • 26 Kosmidou I, Chen S, Kappetein AP. , et al. New-onset atrial fibrillation after PCI or CABG for left main disease: the EXCEL trial. J Am Coll Cardiol 2018; 71 (07) 739-748
    CrossrefPubMedGoogle Scholar
  • 27 Djaiani G, Phillips-Bute B, Podgoreanu M. , et al. The association of patent foramen ovale and atrial fibrillation after coronary artery bypass graft surgery. Anesth Analg 2004; 98 (03) 585-589
    PubMedGoogle Scholar
  • 28 Tran DT, Perry JJ, Dupuis JY, Elmestekawy E, Wells GA. Predicting new-onset postoperative atrial fibrillation in cardiac surgery patients. J Cardiothorac Vasc Anesth 2015; 29 (05) 1117-1126
    CrossrefPubMedGoogle Scholar
  • 29 Mathew JP, Fontes ML, Tudor IC. , et al; Investigators of the Ischemia Research and Education Foundation; Multicenter Study of Perioperative Ischemia Research Group. A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA 2004; 291 (14) 1720-1729
    CrossrefPubMedGoogle Scholar
  • 30 Wazni OM, Martin DO, Marrouche NF. , et al. Plasma B-type natriuretic peptide levels predict postoperative atrial fibrillation in patients undergoing cardiac surgery. Circulation 2004; 110 (02) 124-127
    CrossrefPubMedGoogle Scholar
  • 31 Body SC, Collard CD, Shernan SK. , et al. Variation in the 4q25 chromosomal locus predicts atrial fibrillation after coronary artery bypass graft surgery. Circ Cardiovasc Genet 2009; 2 (05) 499-506
    PubMedGoogle Scholar
  • 32 Kolek MJ, Muehlschlegel JD, Bush WS. , et al. Genetic and clinical risk prediction model for postoperative atrial fibrillation. Circ Arrhythm Electrophysiol 2015; 8 (01) 25-31
    CrossrefPubMedGoogle Scholar
  • 33 Alexandre J, Saloux E, Chequel M. , et al. Preoperative plasma aldosterone and the risk of atrial fibrillation after coronary artery bypass surgery: a prospective cohort study. J Hypertens 2016; 34 (12) 2449-2457
    CrossrefPubMedGoogle Scholar
  • 34 Kashani RG, Sareh S, Genovese B. , et al. Predicting postoperative atrial fibrillation using CHA2DS2-VASc scores. J Surg Res 2015; 198 (02) 267-272
    CrossrefPubMedGoogle Scholar
  • 35 Lancaster TS, Schill MR, Greenberg JW. , et al. Potassium and magnesium supplementation do not protect against atrial fibrillation after cardiac operation: a time-matched analysis. Ann Thorac Surg 2016; 102 (04) 1181-1188
    CrossrefPubMedGoogle Scholar
  • 36 Sareh S, Toppen W, Mukdad L. , et al. CHADS2 score predicts atrial fibrillation following cardiac surgery. J Surg Res 2014; 190 (02) 407-412
    CrossrefPubMedGoogle Scholar
  • 37 January CT, Wann LS, Alpert JS. , et al; ACC/AHA Task Force Members. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation 2014; 130 (23) e199-e267
    PubMedGoogle Scholar
  • 38 Hagens VE, Ranchor AV, Van Sonderen E. , et al; RACE Study Group. Effect of rate or rhythm control on quality of life in persistent atrial fibrillation. Results from the Rate Control Versus Electrical Cardioversion (RACE) Study. J Am Coll Cardiol 2004; 43 (02) 241-247
    CrossrefPubMedGoogle Scholar
  • 39 Crystal E, Connolly SJ, Sleik K, Ginger TJ, Yusuf S. Interventions on prevention of postoperative atrial fibrillation in patients undergoing heart surgery: a meta-analysis. Circulation 2002; 106 (01) 75-80
    CrossrefPubMedGoogle Scholar
  • 40 DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7 (03) 177-188
    CrossrefPubMedGoogle Scholar
  • 41 Deeks JJ, Higgins JPT. Statistical Algorithms in Review Manager 5. Cochrane Collaboration; 2010. http://ims.cochrane.org/revman/documentation/Statistical-methods-in-RevMan-5.pdf
    Google Scholar
  • 42 Benjamin EJ, Levy D, Vaziri SM, D'Agostino RB, Belanger AJ, Wolf PA. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA 1994; 271 (11) 840-844
    CrossrefPubMedGoogle Scholar
  • 43 Dun W, Boyden PA. Aged atria: electrical remodeling conducive to atrial fibrillation. J Interv Card Electrophysiol 2009; 25 (01) 9-18
    CrossrefPubMedGoogle Scholar
  • 44 Manganas H, Lacasse Y, Bourgeois S, Perron J, Dagenais F, Maltais F. Postoperative outcome after coronary artery bypass grafting in chronic obstructive pulmonary disease. Can Respir J 2007; 14 (01) 19-24
    PubMedGoogle Scholar
  • 45 Fuster RG, Argudo JA, Albarova OG. , et al. Prognostic value of chronic obstructive pulmonary disease in coronary artery bypass grafting. Eur J Cardiothorac Surg 2006; 29 (02) 202-209
    CrossrefPubMedGoogle Scholar
  • 46 Lip GYH, Coca A, Kahan T. , et al; Reviewers. Hypertension and cardiac arrhythmias: a consensus document from the European Heart Rhythm Association (EHRA) and ESC Council on Hypertension, endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS) and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE). Europace 2017; 19 (06) 891-911
    CrossrefPubMedGoogle Scholar
  • 47 Fialová M, Dlugosová K, Okruhlicová L, Kristek F, Manoach M, Tribulová N. Adaptation of the heart to hypertension is associated with maladaptive gap junction connexin-43 remodeling. Physiol Res 2008; 57 (01) 7-11
    PubMedGoogle Scholar
  • 48 Pacchia CF, Dosdall DJ, Ranjan R, DiBella E. Alterations in atrial perfusion during atrial fibrillation. Exp Physiol 2014; 99 (10) 1267-1272
    CrossrefPubMedGoogle Scholar
  • 49 Kato T, Yamashita T, Sekiguchi A. , et al. What are arrhythmogenic substrates in diabetic rat atria?. J Cardiovasc Electrophysiol 2006; 17 (08) 890-894
    CrossrefPubMedGoogle Scholar
  • 50 Pop-Busui R. Cardiac autonomic neuropathy in diabetes: a clinical perspective. Diabetes Care 2010; 33 (02) 434-441
    CrossrefPubMedGoogle Scholar
  • 51 Gami AS, Hodge DO, Herges RM. , et al. Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J Am Coll Cardiol 2007; 49 (05) 565-571
    CrossrefPubMedGoogle Scholar
  • 52 Frost L, Hune LJ, Vestergaard P. Overweight and obesity as risk factors for atrial fibrillation or flutter: the Danish Diet, Cancer, and Health Study. Am J Med 2005; 118 (05) 489-495
    CrossrefPubMedGoogle Scholar
  • 53 Wang TJ, Parise H, Levy D. , et al. Obesity and the risk of new-onset atrial fibrillation. JAMA 2004; 292 (20) 2471-2477
    CrossrefPubMedGoogle Scholar
  • 54 Hillis LD, Smith PK, Anderson JL. , et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011; 124 (23) e652-e735
    PubMedGoogle Scholar
  • 55 DiNicolantonio JJ, Beavers CJ, Menezes AR. , et al. Meta-analysis comparing carvedilol versus metoprolol for the prevention of postoperative atrial fibrillation following coronary artery bypass grafting. Am J Cardiol 2014; 113 (03) 565-569
    CrossrefPubMedGoogle Scholar