Prevalence Of Postoperative Atrial Fibrillation Research Articles

Prevalence of Post-operative Atrial Fibrillation Following Cardiac Surgery among Asian Population and Preferred Treatment Modalities- A Systematic Review

Background: Postoperative atrial fibrillation is a common complication following cardiac surgery. Despite numerous studies, the true prevalence and optimal management strategies remain unclear. This systematic review investigates the prevalence and management techniques followed anmongst Asian population post-cardiac surgery. Methods: A comprehensive search was conducted across multiple databases between 2000 and 2023. Data on study characteristics, prevalence, and treatment modalities were extracted and assessed for quality using standardized tools. Results: Out of 1849 identified studies, 23 met the eligibility criteria, all conducted in Asian countries. The prevalence of POAF ranged from 10 % to 58 % among cardiac surgery patients in individual studies, translating to a calculated mean value of 24.46 % POAF cases in all accumulated eligible studies for prevalence in the Asian population. The prevalence of POAF in the Asian population was calculated to be 20.95%. Treatment modalities such as antiarrhythmics and anticoagulants showed varying efficacy, with dexmedetomidine demonstrating potential preventive effects. Studies highlighted the higher recurrence rates in cardiac surgery compared to non-cardiac surgery patients. Additionally, the association between POAF and adverse outcomes such as stroke and mortality underscores the importance of effective management strategies. Conclusion: Despite limitations in study design and sample sizes, this review provides insights into POAF in Asian cardiac surgery patients. Tailored approaches incorporating antiarrhythmics, anticoagulation, and lifestyle modifications may help mitigate the burden of POAF and improve patient outcomes. Further research is warranted to elucidate optimal management strategies and address existing gaps in knowledge.

Racial Disparities in Atrial Fibrillation After Coronary Artery Bypass: Impact of Left Atrial Volume

BackgroundPrior studies have demonstrated a lower prevalence of postoperative atrial fibrillation (POAF) in Black, Hispanic, Asian, and Native American patients compared with White cohorts after coronary artery bypass grafting. We hypothesized that preoperative differences in left atrial size may explain this disparity. MethodsWe assessed the incidence of new POAF in 1218 patients (215 minority patients and 1003 White patients) undergoing isolated, first-time coronary artery bypass grafting from January 2017 through September 2022. Preoperative left atrial volume index (LAVi) was assessed by transthoracic echocardiography. ResultsMinority patients were younger and more likely to be female, with more comorbidities, including diabetes, prior stroke, and dialysis. There was no difference in postoperative mortality, stroke, renal failure, or reoperation for bleeding between minority and White patients. Whereas minority patients had higher blood product use and longer intensive care unit and postoperative lengths of stay, they experienced a lower incidence of new POAF (19.5% [42/215] vs 29.5% [292/1003]; P = 0.02). Mean LAVi was similar between minority and White patients (30.3 ± 12.6 mL/m2 vs 29.9 ± 10.1 mL/m2; P = .64). However, for White patients, LAVi was higher for patients with POAF than for patients without POAF (31.3 ± 10.9 mL/m2 vs 29.3 ± 9.7 mL/m2; P = .007), whereas for minority patients, LAVi was similar for patients with and without POAF (30.7 ± 26.0 mL/m2 vs 30.3 ± 11.7 mL/m2; P = .84). ConclusionsDespite more comorbidities, higher transfusion rates, and longer length of stay, minority patients had a significantly lower incidence of POAF compared with White patients but no difference in preoperative LAVi. Larger LAVi may be predictive of POAF in White patients but not in minority patients.

CE-452780-3 PREDICTORS OF ATRIAL FIBRILLATION RECURRENCE IN CARDIAC AND NON-CARDIAC PATIENTS WITH POST-OPERATIVE ATRIAL FIBRILLATION

Post-operative atrial fibrillation (POAF) is new onset atrial fibrillation (AF) that occurs within 90 days of surgical procedure. Its underlying mechanism is believed to be related to factors such as inflammation, adrenergic surplus, infections and hypoxia. The predictors of AF recurrence in POAF population are not well defined. Establishing potential predictors of AF recurrence in POAF patients could help clinicians identify patients who are at increased risk of stroke and other complications. The aim of this study is to identify the incidence and predictors of AF recurrence after 90 days in POAF patients who have undergone cardiac surgery (CS) and non-cardiac surgery (NCS). We retrospectively reviewed the medical records of patients who underwent cardiac and non cardiac surgery at Hartford Healthcare System from January 2017 to September 2021. Surgical patients with POAF during their index surgical hospitalization were identified. Of this population patients with recurrence of atrial fibrillation after 90 days were examined. We used multivariate logistic regression to identify predictors of atrial fibrillation recurrence in these patients. Out of 81,244 surgical patients, 6,138 were CS and 75,106 were NCS. Comparing CS to NCS, prevalence of POAF was 10% vs 0.3%, average age was 71 vs 73 years, male (66% vs 53%), Caucasian (92% vs 87%). The rate of AF recurrence after 90 days in CS was 105/606 (17%) and NCS was 63/231 (27%). Predictors of AF recurrence in CS were history of heart failure (OR 2.88; 95% CI 1.53 -5.34, p<0.001) and chronic obstructive pulmonary disease (COPD, OR 5.58, 95% CI 2.77-11.3, p<0.001). In the NCS group, there was a trend towards obstructive sleep apnea and hypertension being predictive of AF recurrence, but it did not meet statistical significance. At the time of admission with recurrent AF, 66% of CS and 63% of NCS patients were on anticoagulation. Our study revealed fewer patients with POAF compared to previous reports. Furthermore, the rate of recurrence is higher in NCS compared to CS patients. Additionally, COPD and heart failure were found to be independent predictors of AF recurrence in CS patients.

Prevalence of Postoperative Atrial Fibrillation and Impact to Nursing Practice-A Cross Sectional Study.

Atrial fibrillation is the most common clinically significant cardiac arrhythmia, and it might lead to heart failure, which prolongs the duration of hospitalization and consequently increases the cost of treatment. Thus, diagnosing and treating atrial fibrillation should be the first line of defense against further complications. This study aimed to determine the incidence rate of postoperative atrial fibrillation and correlation with cardiac surgery on heart valves. A specific aim was to determine the relationship between the prevalence of atrial fibrillation and socio-demographic features. The study has a prospective cross-sectional design. The questionnaire was anonymous, requesting socio-demographic information as inclusion criteria, and the data were analyzed using descriptive statistics methods. The sample was 201 patients. χ2 test and t-test were performed where we found that the frequency of atrial fibrillation was higher in the groups that have had valve surgery compared to other cardiac surgeries (χ2 = 7.695, ss = 2, p = 0.021). Atrial fibrillation increased with the age of the patients, but the prevalence of atrial fibrillation was not correlated with body weight. The results of this this study show that atrial fibrillation was higher in the participants who had valve surgery compared to other cardiac surgeries. There was also an increase in atrial fibrillation in the older participants. The results of this study can help to improve nursing practice and the quality of care for cardiac surgery patients with regard to daily activities, or planning nursing care due to the patient's condition.

Prevalence of Postoperative Atrial Fibrillation Following Off-Pump Coronary Artery Bypass Graft Surgery in Elderly Patients.

Background Atrial fibrillation (AF) is one of the frequent complications following coronary artery bypass surgery. Postoperative atrial fibrillation (POAF) can lead to thromboembolic events and prolong hospital stays. We aimed to determine the prevalence of POAF following off-pump coronary artery bypass surgery (OPCAB) in the elderly population. Materials and Methods This cross-sectional study was carried out between May 2018 to April 2020. Elderly patients (age ≥65 years) admitted for isolated elective OPCAB were eligible for the study. A total of 60 elderly patients were evaluated based on the preoperative and intraoperative risk factors and postoperative outcomes during the hospital stay. Results The mean age was 67.83±4.06 years, and the prevalence of POAF in elderly adults was 48.3%. The mean number of grafts was 3.20±0.73, and ICU stays at 3.43±1.61 days. The mean duration of the hospital stays was 10.03±2.12 days. Although stroke developed in 1.7% of post-CABG patients, no mortality was observed postoperatively. Conclusion POAF is one of the commonly encountered complications following OPCAB. Though OPCAB is a superior revascularization procedure, preoperative planning and attention are especially needed in the elderly to reduce the prevalence of POAF.

Impact of obstructive sleep apnea on new-set atrial fibrillation after septal myectomy in patients with hypertrophic obstructive cardiomyopathy.

BackgroundObstructive sleep apnea (OSA) is associated with a higher prevalence of postoperative atrial fibrillation in patients who underwent cardiac surgery. However, whether OSA is a risk factor for postoperative atrial fibrillation after septal myectomy remains unclear. We hypothesized that OSA was associated with postoperative atrial fibrillation after septal myectomy.MethodsA total of 99 patients with hypertrophic obstructive cardiomyopathy who underwent septal myectomy were included in our manuscript. Polysomnography was performed in all patients, and the heart rhythm was continuously monitored during the perioperative period.ResultsIn the present study, 25 (25.3%) patients developed postoperative atrial fibrillation after septal myectomy. The prevalence of postoperative atrial fibrillation was significantly higher in patients with OSA and increased with the worsening severity of OSA. Notably, the apnea-hypoxia index was significantly higher in patients with postoperative atrial fibrillation among the different OSA groups. In receiver operating characteristic analysis, the area under the curve for the apnea-hypopnea index was 0.785 (95% CI: 0.684–0.887, P<0.001); an apnea-hypopnea index of 10.4 was the optimal cutoff point to predict postoperative atrial fibrillation. In the multivariable analysis, apnea-hypopnea index ≥10.4 (odds ratio: 6.29, 95% CI: 2.18–18.14, P=0.001), moderate-to-severe OSA (odds ratio: 4.88, 95% CI: 1.42–16.86, P=0.01), and left atrium diameter (odds ratio: 1.12, 95% CI: 1.03–1.22, P=0.01) were independent risk factors associated with postoperative atrial fibrillation after adjusting for relevant variables. However, the association between the diagnosis of OSA and postoperative atrial fibrillation was no longer statistically significant.ConclusionsThe severity of OSA reflected by the apnea-hypopnea index in patients with obstructive hypertrophic cardiomyopathy who underwent surgery is an independent risk factor for postoperative atrial fibrillation, which is associated with adverse clinical outcomes.

Triglyceride-Glucose Index Independently Predicts New-Onset Atrial Fibrillation After Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy Beyond the Traditional Risk Factors.

The triglyceride–glucose index is a valuable marker of insulin resistance. However, the predictive value of this index for postoperative atrial fibrillation in patients undergoing septal myectomy remains unclear. A total of 409 patients with hypertrophic obstructive cardiomyopathy who underwent septal myectomy were recruited in this study. The triglyceride–glucose index was calculated for all patients preoperatively. All patients underwent clinical data collection, blood sampling, and standard echocardiographic examinations during hospitalization. The prevalence of postoperative atrial fibrillation was approximately 15% in the present study. Multivariate logistic regression revealed that age (odds ratio [OR]: 1.053, 95% CI: 1.016–1.090, P = 0.004), hypertension (OR: 2.399, 95% CI: 1.228–4.686, P = 0.010), left atrial diameter (OR: 1.101, 95% CI: 1.050–1.155, P < 0.001), and triglyceride–glucose index (OR: 4.218, 95% CI: 2.381–7.473, P < 0.001) were independent risk factors for postoperative atrial fibrillation in patients undergoing septal myectomy. In receiver operating characteristic curve analysis, the triglyceride–glucose index could provide a moderate predictive value for postoperative atrial fibrillation after septal myectomy 0.723 (95% CI: 0.650–0.796, P < 0.001). Moreover, adding the triglyceride–glucose index to conventional risk factor model could numerically but not significantly increase our ability to predict postoperative atrial fibrillation (area under the receiver: 0.742 (0.671–0.814) vs. 0.793 (0.726–0.860), p = 0.065) after septal myectomy. In our retrospective cohort study, the triglyceride–glucose index was identified as an independent predictor of postoperative atrial fibrillation in patients undergoing septal myectomy.

Incidence and factors associated with pericardial effusion after cardiac valve surgery

Introduction: Pericardial effusion (PE) is a postoperative complication of cardiac valve surgery, related to early hospital readmissions and death. We aimed to describe its incidence and to identify predictive factors of moderate-to-severe PE in a contemporary cohort. Methods: We retrospectively reviewed medical records of all consecutive patients submitted to cardiac valve surgery in a tertiary teaching hospital from January 2012 to July 2014, where echocardiography was routinely performed before patient discharge. Moderate-to-severe PE was defined as ≥ 10 mm of thickness, or signs of cardiac tamponade on echocardiography. Additional clinical and perioperative data were extracted from medical records using a standardized protocol. Results: Of 353 patients, 335 underwent a predischarge echocardiography. From these, 27 patients (8%; mean age: 62 years; standard deviation 12 years; 70% male) had moderate-to-severe PE. These patients had a higher prevalence of previous stroke (22% vs. 8%; p = 0.009) and oral anticoagulation (international normalized ratio > 2) prior to the surgery (11 vs. 2%; P = 0.002). In patients with moderate-to-severe PE, surgeries had longer ischemia (p < 0.001) and cardiopulmonary bypass (p < 0.001) times, and the prevalence of postoperative atrial fibrillation was higher (56% vs. 32%; p = 0.011) than in patients with absent or small PE. Hospital mortality was also higher (15% vs. 3%; p = 0.002) in patients with moderate-to-severe PE. Conclusions: Eight percent of patients submitted to cardiac valve surgery developed moderate-to-severe PE. Moreover, PE was associated with pre- and post-surgery conditions likely related to the coagulation state, though a cause-effect relationship could not be inferred. Noteworthy, this condition was associated with higher in-hospital morbidity and mortality. Keywords: Adult; pericardium; postoperative care

Time-Related Prevalence of Postoperative Atrial Fibrillation After Stand-Alone Minimally Invasive Radiofrequency Ablation

We present our results with minimally invasive surgical treatment of lone atrial fibrillation (LAF) employing a radiofrequency (RF) source through a bilateral thoracoscopy. Between January 2007 and January 2011, 28 consecutive patients (85.7% male, mean age 67.1 ± 9.1 years) with LAF underwent video-assisted bilateral RF ablation. Fourteen patients (50%) had paroxysmal, five (17.8%) persistent, and nine (32.2%) long-persistent LAF. All patients were followed-up according to the Heart Rhythm Society/ European Heart Rhythm Association/European Cardiac Arrhythmia Society (HRS/EHRA/ECA) and success/failure was reported as suggested by Society of Thoracic Surgeon (STS) guidelines. Mean follow-up was 27.8 ± 8.6 months. Time-related prevalence of postoperative AF was 4.5% at 36 months. Success was much more likely in subjects with paroxysmal (3-year prevalence, 0%) or persistent (3-year prevalence, 0%) than long-standing persistent LAF (3-year prevalence, 8.3%). At 36 months the estimated prevalence of antiarrhythmic drugs was 11.3% (8.8 to 13.7). No major thromboembolic events were detected during the follow-up period and 36-month prevalence of Warfarin use was 15.2% (11.5 to 18.1). Finally, no patient underwent electrical cardioversion. This approach yielded satisfactory results with a high degree of safety. Further larger studies are necessary to confirm our findings.

Risk-Stratified Evaluation of Amiodarone to Prevent Atrial Fibrillation After Cardiac Surgery

Amiodarone prophylaxis (AMP) reduces the prevalence of postoperative atrial fibrillation (POAF) after cardiac surgery. We investigated the impact of AMP on the frequency and duration of POAF, the intensive care unit and hospital length of stay, and its cost-effectiveness in a risk-stratified cohort. A retrospective, observational analysis of 509 patients who underwent cardiac surgery in 2003 was performed. Data sources included The Society of Thoracic Surgeons national database; medical and medication administration records; and the activity-based cost data from our institution. Risk stratification for POAF was determined using a validated risk index. Cost-effectiveness was determined from the hospital's perspective. The mean patient age was 63 years, 27% were female, 80% underwent coronary artery bypass grafting, and 29% underwent valve surgery. When a risk-stratified evaluation was made, 50% of patients were at an elevated risk for having POAF develop. When compared with nonprophylaxed patients, those receiving AMP (59%) experienced less POAF (31% vs 22%; p = 0.027) and shorter durations of POAF (4.7 vs 2.7 days; p = 0.025). In the elevated-risk group, AMP clinically (but not significantly) reduced length of stay in the intensive care unit (101 vs 68 hours; p > 0.05) and post-procedural hospital length of stay (9.7 vs. 7.9 days, p > 0.05). In the elevated-risk group, AMP was robustly cost-effective in reducing POAF. Amiodarone prophylaxis reduced the prevalence and duration of POAF. Baseline risk for POAF was a major determinant of the overall cost-effectiveness of AMP. The greatest cost savings with AMP was seen in patients at an elevated risk for POAF. These findings suggest the need for risk stratification when prescribing AMP.

Surgery for Permanent Atrial Fibrillation: Impact of Patient Factors and Lesion Set

Whether a complete Cox-maze procedure is needed to ablate permanent atrial fibrillation in patients undergoing concomitant cardiac surgery is unknown. Our objective was to assess the effectiveness of different lesion sets in such patients. From November 1991 to January 2004, 575 patients underwent surgical treatment of permanent atrial fibrillation (duration > 6 months); mitral valve disease was the primary indication for surgery in 74%. Procedures included pulmonary vein isolation alone (n = 68, 12%), pulmonary vein isolation with left atrial connecting lesions (n = 265, 46%), and Cox-maze (n = 242, 42%). Rhythm documented on 5,120 postoperative electrocardiograms was used to estimate time-related prevalence of, and risk factors for, atrial fibrillation. Prevalence of postoperative atrial fibrillation peaked at 46% two weeks after operation, declining to 24% at one year. Patient-related risk factors for increased prevalence included older age (p < 0.0001), larger left atrium (p < 0.0001), and longer duration of preoperative atrial fibrillation (p = 0.0008). The Cox-maze procedure and lesion sets resembling it created with alternative energy sources had a similarly low prevalence of late postoperative atrial fibrillation; in contrast, pulmonary vein isolation and lesion sets that did not include a lesion to the mitral anulus were less effective. This study suggests that in cardiac surgical patients with permanent atrial fibrillation the left atrial lesion set should include wide pulmonary vein isolation, at least one connection between right and left pulmonary veins, and a connection to the mitral anulus. Availability of alternative energy sources to create lesions sets has virtually eliminated the need for the cut-and-sew Cox-maze procedure.

Atrial fibrillation in elderly patients after coronary artery bypass grafting; gender differences in outcome

Objectives. To evaluate gender-related differences in preoperative risk factors, hospital events, especially atrial fibrillation (AF), and length of stay in elderly patients undergoing isolated coronary artery bypass grafting (CABG). Design. Prospectively collected data from consecutive patients undergoing isolated CABG in Tampere University Hospital between May 1999 and November 2000, in total 1 131 patients. Result. We analysed 621 patients 65 years and older of whom 401 (65%) were male. When evaluating gender differences we found that the women were older (73 vs. 71 yrs, p<0.001) and significantly more often had hypertension (66% vs. 49%, p<0.001) and chronic heart insufficiency (11% vs. 4%, p=0.001). The NYHA classification of the women was worse (3.4 vs. 3.1, p<0.001) and in the angiografic data they had left main stenosis more often (31% vs. 21%, p=0.005) than the men. The women needed longer hospitalisation (19 vs. 15 days, p<0.001). There was no difference in the prevalence of postoperative AF between the genders, but in spite of that women had more postoperative strokes (6% vs. 3%, p=0.028) and also other major complications (29% vs. 19%, p=0.004) than the men. The 30-day mortality was higher in the female group (8% vs. 5%, p=0.06). We analysed preoperative risk factors and found that the females had a 1.6-fold risk for postoperative major complication after adjustment for age and other risk factors. In a logistic regression analysis age and the number of anastomoses emerged as independent predictors of AF in males, but in females we could not find any predictor for postoperative AF. Conclusions. The women are older and have more comorbidities and risk factors at the time of CABG. They also have more postoperative complications, but not a significantly higher mortality. Importantly, the excess of morbidity remains after adjustment for age and underlying risk factors. There is no gender difference in the incidence of postoperative AF in the elderly population. However, it seems to occur independent of age in the women only.

Off-pump complete revascularization through a left lateral thoracotomy (ThoraCAB): the first 200 cases

Background Conventional coronary bypass surgery is associated with substantial morbidity caused by cardiopulmonary bypass (CPB) and median sternotomy. This report describes an innovative technique to perform complete revascularization through a lateral thoracotomy without CPB (thoraCAB). Methods From February 2000 to April 2001 a total of 200 patients underwent thoraCAB. The patient is positioned with the left side elevated to 45 degrees. A 5- to 6-inch incision is made over the left fourth or fifth intercostal space from just medial to the nipple to the anterior axillary line. The left internal thoracic artery is harvested as a pedicle graft under vision. Proximal anastomoses are first completed on the ascending aorta, followed by the distal coronary anastomoses on the beating heart using a stabilizer. Intercostal nerve freezing is done using a cryoprobe. Results Complete revascularization was achieved in all patients. The number of grafts averaged 2.9 ± 1.08 per patient. One patient (0.5%) died of renal failure. Two patients (1%) were converted to CPB. No strokes were observed. Three patients (1.5%) required prolonged ventilation (>48 hours). Five patients (2.5%) had postoperative bleeding requiring reexploration. Of the patients, 16 (8%) developed new-onset postoperative atrial fibrillation. Conclusions ThoraCAB has been feasible in the vast majority of patients requiring coronary bypass surgery. The prevalence of postoperative atrial fibrillation was low. Postoperative pain maybe lessened with intercostal nerve freezing.

Prevention of atrial fibrillation in the postoperative cardiac patient: significance of oral class III antiarrhythmic agents

Atrial fibrillation is a frequent complication of cardiac surgery and the most common reason for delay in discharge from the hospital after open-heart surgery. This review summarizes the results of studies that have examined the prophylactic value of orally administered sotalol and amiodarone in preventing atrial fibrillation after open-heart surgery. The reduction in the prevalence of postoperative atrial fibrillation is 50–90% for sotalol compared with 50–60% for amiodarone. Sotalol has a rapid onset of action, allowing it to be efficacious when used orally shortly after surgery. In contrast, amiodarone has a slow onset of action that necessitates either oral loading for several days before surgery or intravenous loading shortly before or after surgery. However, although patients who are poor candidates for β blockade may not tolerate sotalol, amiodarone does not have this limitation. Although both sotalol and amiodarone have relative advantages and disadvantages, available data indicate that either agent can be used effectively in selected patients to reduce the risk of postoperative atrial fibrillation. Larger controlled comparative trials are needed to define the precise magnitude of benefit from these compounds relative to their side effect profiles.

Atrial fibrillation early postoperatively following minimally invasive cardiac valvular surgery

We report a cohort of our first 100 minimally invasive cardiac valvular operations matched 1:1 by age and valvular surgery type with patients undergoing a traditional midline sternotomy approach. The prevalence of postoperative atrial fibrillation among patients with minimally invasive procedures versus traditional midline sternotomy was 26.3% versus 38.0%, respectively (p = 0.08). Neither multiple logistic regression nor Kaplan-Meier distribution analysis identified differences in postoperative atrial fibrillation between the 2 surgical techniques.