Factors associated with the development of early postoperative atrial fibrillation in patients after non-cardial surgery

Background.Cardiac arrhythmias remain a clinically significant problem in the conditions of the general surgical department, since they make a significant contribution to the risk of fatal complications. The aim of the study. To study the clinical, instrumental and laboratory characteristics of patients depending on the development or absence of a fatal outcome after non-cardial abdominal surgical interventions, as well as to evaluate the effect of early atrial fibrillation on mortality. Methods. The methodology was carried out according to the type of "case-control" study. 83 lethal "cases" were selected and 143 "controls" were selected. A total of 226 medical histories are included in the analysis. Results.The group with mortality was significantly older than the group without mortality: 75 (64;82) years versus 61 (44;72) years, respectively (p<0.001). Differences in the groups were observed in the severity of concomitant pathology: in the group with mortality, CHF was significantly more pronounced (p<0.001), diabetes mellitus was more common – 34% vs. 10% (p<0.001) and the frequency of COPD was higher – 8.4% vs. 1.4% (p=0.031). However, there were no statistically significant differences in the frequency of myocardial infarction (p=0.121). Statistically significant differences in perioperative parameters included differences in intraoperative infusion of solutions with a volume of more than 3 liters (p=0.003) and in postoperative infusion of solutions with a volume of 1-3 liters and 3-5 liters (p=0.001 and p<0.001). In the group with a fatal outcome, infusion in large volumes significantly prevailed. Also, the group with a fatal outcome was statistically significantly different in the frequency of relaporotomies (p<0.001).; by the frequency of systemic inflammatory reaction syndrome (p<0.001), by the frequency of bleeding (p=0.031), by the frequency of AFP (p<0.001), thromboembolic complications (p<0.001) and the frequency of pneumonia (p<0.001). All of the above events were more often observed in the group of patients with a fatal outcome. Statistically significant independent factors increasing the risk of mortality in our sample were: history of cardiac arrhythmias (OR 3.4 at 95% CI 1.7-6.9), CHF 2-3 FC (OR 6.8 at 95% CI 3.7-12.6), DM (OR 4.9 at 95% CI 2.3-9.6), COPD (OR 6.5 at 95% CI 1.3-32), intraoperative infusion of more than 3 liters (OR 2.9 at 95% CI 1.46-5.7), postoperative infusion of 3-5 liters (OR 2.9 at 95% CI 1.6-5.0), thromboembolic complications (OR 37.9 at 95% CI 8.7-164). Conclusions.Statistically significant independent factors that increase the risk of mortality are: a history of cardiac arrhythmias, heart failure, chronic obstructive pulmonary disease, large infusion of solutions during and after surgery, diabetes mellitus, the development of thromboembolic complications. The development of postoperative atrial fibrillation increases the chances of a fatal outcome by 15 times: the odds ratio was 14.8 with 95% CI from 7.4 to 29.4.

Supplementation of n-3 polyunsaturated fatty acids to prevent postoperative atrial fibrillation in patients subjected to heart surgery

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Several randomized clinical trials evaluated whether preoperative supplementation of omega-3 (n-3) polyunsaturated fatty acids protects against postoperative atrial fibrillation after cardiac surgery, a condition associated with increased cardiac and cerebral mortality. However, their efficacy remains still controversial. An updated meta-analysis was performed to clarify if preoperative n-3 polyunsaturated fatty acid supplementation prevents postoperative atrial fibrillation in patients undergoing cardiac surgery. Articles were retrieved until November 2012 by screening electronic databases (PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials) and cross references. Two of us independently reviewed articles and agreed to select 8 randomized clinical trials. For each study, the incidence of atrial fibrillation in both the intervention and placebo groups was extracted to calculate odd ratio and 95% confidence intervals (CIs). Weighted study-specific estimates were combined using fixed (Mantel-Haenszel method) and random-effects (DerSimonian-Laird method) models. This meta-analysis includes 2687 patients (1337 in the intervention group) who underwent cardiac surgery. Pooled analysis using fixed-effects models showed a significant reduction (average, 16%; 95% CI, 1%-29%) in postoperative atrial fibrillation by preoperative n-3 polyunsaturated fatty acids. There was a low heterogeneity among studies (P=.07 and I(2)=46%). By using a random-effects model, the reduction averaged 25% (odds ratio, 0.75; 95% CI, 0.57-1.00; P=.05). When isolated coronary artery bypass graft surgery was only considered (7 studies), a significant protection averaging 34% was observed in a fixed model (odds ratio, 0.66; 95% CI, 0.50-0.87; P=.003; I(2)=26%, P=.23). A preoperative supplementation of n-3 polyunsaturated fatty acids significantly prevents the occurrence of postoperative atrial fibrillation in patients undergoing cardiac surgery, in particular coronary artery bypass surgery.

Background. Atrial fibrillation (AF) is one of the most common complication after cardiac surgeries. Age, valvular heart disease, heart failure, chronic obstructive pulmonary disease and a history of AF are well known risk factors for postoperative AF. On the other hand, hyponatremia is also a frequent disorder in patients undergoing cardiac surgery but its relationship with AF has not been studied. Purpose. We evaluated the impact of hyponatremia on the incidence of postoperative AF in patients undergoing cardiac surgery with cardiopulmonary bypass. Methods. The retrospective study included case history of 222 patients (174 men and 48 women, median age 64.5 [range 58.0; 69.0] years) who underwent cardiac surgery with cardiopulmonary bypass between January 2015 and December 2018. In all patients intraoperative sodium level was analyzed. Hyponatremia was defined as serum sodium level < 135 mmol/l. Primary outcome was the episode of AF in postoperative period. Results. The incidence of postoperative AF was 18.9% (95% confidence interval (CI) 14.1-24.3 P = 0.05). Patients with AF more often had obesity, diabetes mellitus and a history of myocardial infarction and were more likely to perform combined surgery compared to non-AF patients (all Ps < 0.05). The prevalence of hyponatremia was significantly higher among AF group compared with non-AF (95.2% versus 77.8%, P = 0.017). Hyponatremia was the independent risk factors of postoperative AF in Cox regression models adjusted for covariates (odds ratio 5.31; 95% CI 1.42-18.7; P = 0.017). Conclusion. In this analysis serum sodium level was closely associated with the risk of AF. These findings suggest that hyponatremia may cause the development of postoperative AF in patients undergoing cardiac surgery with cardiopulmonary bypass.

To evaluate the effect of perioperative statin treatment on postoperative atrial fibrillation and cardiac mortality in patients undergoing coronary artery bypass grafting. A total of 1890 patients who underwent isolated coronary artery bypass were analyzed retrospectively, of which 425 patients (22.4%) older than 70 were included in the study. The demographic properties, preoperative, operative and postoperative data and other medications of these patients were recorded. Continuous preoperative and postoperative atorvastatin therapy were received by 124 (29.17%) patients; 301 (70.82%) patients were matched to a control group (no-statin group). The two groups were matched by propensity score analysis in terms of atrial fibrillation development and cardiac mortality. Medical history, medical treatment, cardiovascular history, and operative characteristics demonstrated significant heterogeneity in both groups. Postoperative atrial fibrillation was similar in both groups. Before propensity score matching, the percentages of patients in postoperative atrial fibrillation with respect to Atorvastain-group and No-statin-group were 13.71 and 10.3 respectively; however, those were 13.71 and 14.51 after matching. In a multivariate regression analysis, five-vessel bypass (odds ratio OR, 2.354; 95% confidence interval CI, 0.99 to 5.57) was an independent predictor of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting. In-hospital mortality was higher in the Atorvastatin-group compared with the No-statin-group: 124 (8.9%) versus 301 (3.7%), respectively; p=0.027). Perioperative atorvastatin treatment is not found to be associated with reduced postoperative atrial fibrillation and cardiac mortality in patients undergoing isolated coronary artery bypass grafting above the age of seventy years.

Objective: This study aimed to investigate whether the preoperative Systemic Immune-Inflammation Index (SII) can predict the development of postoperative atrial fibrillation (PoAF) in patients undergoing coronary artery bypass grafting (CABG) with low ejection fraction (EF). Materials and Methods: Between January 2023 and January 2024, 100 patients who underwent CABG with low EF(40%) were included in the study. Preoperative SII values of the patients, along with their demographic characteristics and operative variables, were compared. Results: Among the 100 patients with reduced ejection fraction included in the study, postoperative atrial fibrillation was identified in 10 cases. No significant differences were observed in the demographic and perioperative data of the patients. The SII levels were found to be higher in ten patients who developed PoAF, demonstrating a correlation (p=0.008). PoAF patients experienced a longer stay in the hospital although statistically insignificant (p=0.059). Conclusion: Preoperative SII levels may be effective in predicting postoperative atrial fibrillation in coronary bypass patients with low ejection fraction.

Atrial fibrillation is a frequent cause of morbidity following coronary artery bypass grafting (CABG). SYNTAX score II (SSII) is associated with outcomes in patients undergoing coronary revascularization. We investigated the relationship between SSII and postoperative atrial fibrillation (POAF) in patients undergoing CABG. Records of 461 consecutive patients who underwent elective isolated CABG were retrospectively reviewed. Characteristics of patients with and without POAF were compared. POAF developed in 51 (11.1%) patients. Patients with POAF were older (61.8 ± 7.8 versus 58.4±7.7; P = .003). Chronic obstructive pulmonary disease (COPD) and history of coronary artery disease (CAD) were more frequent in patients with POAF whereas the frequency of hypertension (HT), diabetes mellitus (DM), and smoking did not differ. CRP was significantly higher in patients with POAF. Left atrial diameter (LAD), EuroSCORE II, SSI and SSII were greater in patients with POAF (P < .001 for all). Age, history of CAD, LAD, SSI, and SSII were independent predictors of POAF in multivariate regression analysis. In ROC analysis, SSII was more accurate than SSI for predicting POAF, albeit statistically insignificant [difference between AUC: 0.0483, 95% CI (-0.0411) - (0.138); z statistic:1.059, P = .29)]. In-hospital MACE (3.2% versus 9.8%, P = .038) and one-year mortality (4.6% versus 13.5%, P = .008) of patients with POAF were significantly higher. POAF occurred in more than one-tenth of patients undergoing CABG, and it is associated with in-hospital MACE and one-year mortality. Age, history of CAD, LAD, SSI, and SSII are independent predictors of POAF. SSII seems to be more accurate than SSI for predicting POAF.

Anti-Inflammatory Role of Statins in Preventing Postoperative Atrial Fibrillation

Catheter ablation for persistent atrial fibrillation in an elderly patient with cor triatriatum sinister

Purpose: Atrial fibrillation is the most common arrhythmia following cardiac surgery. An association between preoperative kidney dysfunction and postoperative atrial fibrillation has been previously reported; however, no study has so far investigated the impact of kidney function during cardiopulmonary bypass on the incidence of atrial fibrillation. The aim of this study was to investigate the value of preoperative renal function and urine output during cardiopulmonary bypass as predictors of postoperative atrial fibrillation in patients undergoing elective coronary artery bypass. Methods: This observational retrospective study included 409 patients who underwent elective coronary artery bypass surgery. According to whether or not atrial fibrillation developed postoperatively, the patients were divided into a sinus rhythm group (n = 340) and a new-onset atrial fibrillation group (n = 69). The impact of preoperative (serum creatinine and estimated glomerular filtration rate) and intraoperative (urine output during cardiopulmonary bypass) kidney function on the incidence of new-onset postoperative atrial fibrillation was assessed using univariable and multivariable analyses. Results:Patients with atrial fibrillation were older, and had higher EuroSCORE II and higher preoperative B-type natriuretic peptide levels than patients with sinus rhythm. Preoperative renal function was worse (higher serum creatinine level and lower estimated glomerular filtration rate) in the atrial fibrillation group than in the sinus rhythm group. However, there were no differences between the groups in urine output during cardiopulmonary bypass. Multivariable analysis identified older age, left ventricular ejection fraction ≤30%, and lower preoperative estimated glomerular filtration rate as independent risk factors for new-onset postoperative atrial fibrillation. Conclusion: Preoperative renal function—but not urine output during cardiopulmonary bypass—is a predictor of new-onset postoperative atrial fibrillation in patients undergoing elective coronary artery bypass surgery.

A best evidence topic was written according to a structured protocol. The question addressed was whether plasma brain natriuretic peptide (BNP) levels could effectively predict the occurrence of postoperative atrial fibrillation (AF) in patients undergoing non-cardiac thoracic surgery. A total of 14 papers were identified using the reported search, of which 5 represented the best evidence to answer the clinical question. The authors, date, journal, country, study type, population, outcomes and key results are tabulated. All studies were prospective observational, and all reported a significant association between BNP and N-terminal (NT)-proBNP plasma levels measured in the immediate preoperative period and the incidence of postoperative AF in patients undergoing either anatomical lung resections or oesophagectomy. One study reported a cut-off value of 30 pg/ml above which significantly more patients suffered from postoperative AF (P < 0.0001), while another one reported that this value could predict postoperative AF with a sensitivity of 77% and a specificity of 93%. Another study reported that patients with NT-proBNP levels of 113 pg/ml or above had an 8-fold increased risk of developing postoperative AF. These findings support that BNP or NT-proBNP levels, especially when determined during the preoperative period, if increased, are able to identify patients at risk for the development of postoperative AF after anatomical major lung resection or oesophagectomy. The same does not seem to be true for lesser lung resections. These high-risk patients might have a particular benefit from the administration of prophylactic antiarrhythmic therapy.

The aim of this paper was to determine whether vitamin D supplementation reduces the incidence of postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass grafting (CABG). PubMed and Cochrane Central Register of Controlled Trials were systematically searched from inception through May 2023 for randomized controlled trials (RCTs) assessing the effectiveness of Vitamin D in preventing atrial fibrillation among postoperative patients after CABG. The primary outcome extracted was the incidence of atrial fibrillation after Vitamin D in CABG patients. Secondary outcome included the length of hospital stay. Data were pooled using a random-effect model. A total of 4 RCTs, involving 694 patients, were included in the final analysis. The results showed that Vitamin D supplementation significantly reduced the incidence of POAF in CABG patients (RR: 0.55; 95% CI: 0.40 to 0.76; P=0.0003; I2=1%). However, administration of Vitamin D did not lead to significant reduction in the length of hospital stay (WMD: -0.14; 95% CI: -0.82 to 0.53; P=0.68; I2=34%). Our updated pooled analysis concludes that vitamin D reduces the incidence of POAF in CABG patients. Future large-scale studies should focus on more diverse patient populations and explore a broader range of outcomes to better understand the full impact of Vitamin D supplementation in this context.

Aims:To determine whether vitamin D supplementation reduces the incidence of postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass grafting (CABG).Methods and Results:PubMed and Cochrane Central Register of Controlled Trials were systematically searched from inception through May 2023 for randomized controlled trials (RCTs) assessing the effectiveness of Vitamin D in preventing atrial fibrillation among postoperative patients after CABG. The primary outcome extracted was the incidence of atrial fibrillation after Vitamin D in CABG patients. Secondary outcome included the length of hospital stay. Data were pooled using a random-effect model. A total of 4 RCTs, including 694 patients, were included in the final analysis. The results showed that Vitamin D supplementation significantly reduced the incidence of POAF in CABG patients (RR: 0.55; 95% CI: 0.40 to 0.76; P = 0.0003; I2 = 1%). However, administration of Vitamin D did not lead to significant reduction in the length of hospital stay (WMD: − 0.14; 95% CI: − 0.82 to 0.53; P = 0.68; I2 = 34%).Conclusion:Our updated pooled analysis concludes that Vitamin D reduces the incidence of POAF in CABG patients. Future large-scale studies should focus on more diverse patient populations and explore a broader range of outcomes to better understand the full impact of Vitamin D supplementation in this context.

Do off-pump techniques reduce the incidence of postoperative atrial fibrillation in elderly patients undergoing coronary artery bypass grafting?