Factors affecting the occurrence of postoperative atrial fibrillation in cardiac surgery patients

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Intorduction. Postoperative atrial fibrillation (POAF) is the most common arrhythmia after cardiac surgery and is a serious clinical problem. POAF refers to new-onset atrial fibrillation developing immediately after surgery. Despite advances in surgical and perioperative techniques, it remains the most common adverse event in cardiac surgery. Many studies are being conducted to obtain detailed information on the mechanisms underlying POAF, its course and effective treatment methods. Despite a significant improvement in treatment outcomes after cardiac surgery, the incidence of POAF did not change. It continues to be a major burden for patients, physicians and healthcare systems increasing hospitalization and healthcare costs as reflected in longer hospital stays, increased post-operative complications and increased mortality. Purpose Identification of factors determining the occurrence of POAF in patients after cardiac surgery. Material and Methods 125 patients (53 women, 72 men, mean age 68.68 ± 7.11) qualified for elective cardiac surgery were included in the study. Patients with persistent or paroxysmal atrial fibrillation diagnosed before the procedure were excluded from the study. The study took into account a number of sociodemographic and clinical data, which were collected on the basis of patients' medical records from the course of hospitalization (sex, age, weight, height, BMI, place of residence, type of surgery, duration of surgery, perioperative risk according to EuroScore II, results of laboratory tests before and after surgery, the presence of comorbidities and multi-morbidity, hospitalization time). In addition, the score obtained in the CHA2DS2–VASc scale was taken into account in the analysis. The assumed significance level was p < 0.05. Results POAF was identified in 41% of patients. The average perioperative risk in the study group was M± SD = 2.05 ± 1.61. It was noted that POAF is significantly more common in women than in men (21.6% vs. 19.2%; p = 0.048). Patients with POAF had a significantly higher BMI than patients without POAF (29.20±3.81 vs. 27.89±4.14, p = 0.38). In patients with POAF, a statistically significant correlation was found between the loss of platelets during the procedure and the length of hospitalization (r = -0.387, p<0.005). In the study group, there was no relationship between the occurrence of POAF and the type of surgery, duration of surgery, loss of hemoglobin, total protein, decrease in potassium levels, the presence of comorbidities, multimorbidity, CHA2DS-VAc score). Conclusions 1. Female sex is an unmodifiable factor determining the occurrence of POAF in cardiac surgery. 2. Overweight is a modifiable factor determining the occurrence of POAF in cardiac surgery. 3. Perioperative platelet loss in patients with POAF results in longer hospital stay after cardiac surgery.