Abstract
BackgroundPostoperative atrial fibrillation (POAF) is the most common cardiac dysrhythmia to occur after coronary artery bypass grafting (CABG). However, the risk factors for new-onset POAF after CABG during the perioperative period have yet to be clearly defined. Accordingly, the aim of our systematic review was to evaluate the perioperative predictors of new-onset POAF after isolated CABG.MethodOur review methods adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. We searched seven electronic databases (PubMed, Embase, CINAHL, PsycArticles, Cochrane, Web of Science, and SCOPUS) to identify all relevant English articles published up to January 2020. Identified studies were screened independently by two researchers for selection, according to predefined criteria. The Newcastle–Ottawa Scale was used to evaluate the quality of studies retained.ResultsAfter screening, nine studies were retained for analysis, including 4798 patients, of whom 1555 (32.4%) experienced new-onset POAF after CABG. The incidence rate of new-onset POAF ranged between 17.3% and 47.4%. The following risk factors were identified: old age (p < 0.001), a high preoperative serum creatinine level (p = 0.001), a low preoperative hemoglobin level (p = 0.007), a low left ventricle ejection fraction in Asian patients (p = 0.001), essential hypertension (p < 0.001), chronic obstructive pulmonary disease (p = 0.010), renal failure (p = 0.009), cardiopulmonary bypass use (p = 0.002), perfusion time (p = 0.017), postoperative use of inotropes (p < 0.001), postoperative renal failure (p = 0.001), and re-operation (p = 0.005). All studies included in the analysis were of good quality.ConclusionsThe risk factors identified in our review could be used to improve monitoring of at-risk patients for early detection and treatment of new-onset POAF after CABG, reducing the risk of other complications and negative clinical outcomes.
Highlights
Postoperative atrial fibrillation (POAF) is the most common cardiac dysrhythmia to occur after coro‐ nary artery bypass grafting (CABG)
The risk factors identified in our review could be used to improve monitoring of at-risk patients for early detection and treatment of new-onset POAF after CABG, reducing the risk of other complications and negative clinical outcomes
The possibility of publication bias cannot be completely excluded as the number of articles for each variable ranged between two and nine. Despite these limitations, using findings based on prospective studies, we revealed that old age, a high preoperative serum creatinine level, a low Left ventricle ejection fraction (LVEF) in Asian populations, a low hemoglobin level, essential hypertension, chronic obstructive pulmonary disease (COPD), renal failure, cardiopulmonary bypass (CPB) use and duration of perfusion, use of postoperative inotropes, postoperative renal failure, and re-operation were significantly associated with new-onset POAF after CABG
Summary
Postoperative atrial fibrillation (POAF) is the most common cardiac dysrhythmia to occur after coro‐ nary artery bypass grafting (CABG). The risk factors for new-onset POAF after CABG during the perioperative period have yet to be clearly defined. The aim of our systematic review was to evaluate the perioperative predictors of new-onset POAF after isolated CABG. Recent research has indicated that new-onset POAF after CABG has a long-term thromboembolic risk profile similar to that of non-valvular atrial fibrillation (AF) [11, 12]. Identification of patients who are at risk of new-onset POAF after CABG is clinically important to ensure adequate precautions during the perioperative period to optimize clinical outcomes. Systematic reviews regarding the relationship between POAF and adverse outcomes after CABG have largely focused on mortality [8, 12, 15]. As risk models based only on preoperative risk factors cannot identify all patients who develop POAF [17], it is necessary to identify the risk factors that can be continuously monitored during and after CABG for optimal care
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