A comparison of four risk models for the prediction of cardiovascular complications in patients with a history of atrial fibrillation undergoing non‐cardiac surgery

Atrial fibrillation is one of the most common complications after cardiac surgery and is associated with adverse outcomes such as increased mortality, neurological problems, longer hospitalizations, and increased cost of care. Major risk factors for the development of postoperative atrial fibrillation include older age and a history of atrial fibrillation. β-Blockers are the most effective preventive therapy, although sotalol and amiodarone can also be used for prophylaxis. In the postoperative period, the nurse plays an important role in the early detection of atrial fibrillation by the recording of an atrial electrogram, which is easily obtained from the bedside monitor. Because an atrial electrogram records larger atrial activity than ventricular activity, it can be invaluable in establishing the diagnosis of postoperative atrial fibrillation. Once atrial fibrillation begins, treatment can be started with either rhythm conversion or rate-controlling medications.

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Risk Factors for Atrial Fibrillation following a Cardiac Surgery

10.22541/au.163256940.04888608/v1 ◽

2021 ◽

Author(s):

Ibrahim Marai ◽

Wiaam Khatib ◽

Liza Grosman-Rimon ◽

Shemy Carasso ◽

Ali Sakhnini ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Cardiac Surgery ◽

Cox Regression ◽

Medical Center ◽

Clinical Impact ◽

Cox Regression Analysis ◽

History Of ◽

Vascular Accidents ◽

Preoperative Factors

Background: Atrial fibrillation (AF) following cardiac surgery is common and has clinical impact on morbidity. The preoperative and intraoperative risk factors are still not well defined. The objective of the study was to examine preoperative and intraoperative risk factors for AF following cardiac surgery. Methods: A retrospective analysis of a database of cardiac surgeries was performed during 2017-2019 at Poriya Medical Center. Preoperative factors and intraoperative were recorded. Results: 208 patients were included in this analysis. Overall AF following cardiac surgery was detected in 50 (24%) patients. Of 175 patients who did not have history of AF prior to surgery, 27 (15.5%) had post-operative AF. In the 33 patients with previous AF, AF following surgery was detected in 23 (70%). Patients with AF following surgery who were older (66.2±8.0 vs. 60.7± 11.4 years, p=0.002), were treated more with anti-arrhythmic drugs (18.9% vs 4.5, p<0.001), and had higher rates of pre-operative AF (46% vs 6.3%, p=0.0001), prior cerebral vascular accidents (14% vs 4.4%, p=0.019), and prior valve replacement (10% vs 1.9%, p=0.009) compared to patients without AF following surgery. In multivariate Cox regression analysis, age (HR 1.04, CI 1.01-1.07, P=0.006) and history of preoperative AF (HR 6.01, CI 3.42-10.57, P<0.001) were predictors of AF following cardiac surgery. The probability of being free of postsurgical AF was 80% among patients without history of AF compared to 30% in patients with previous AF history (p<0.001). Conclusion: Preoperative AF and age were predictors of AF following cardiac surgery

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Postoperative atrial fibrillation as a risk factor for cardiovascular complications in non-cardiac surgery

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2020-2540 ◽

2020 ◽

Vol 19 (4) ◽

pp. 2540

Author(s):

O. N. Dzhioeva ◽

O. M. Drapkina

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Perioperative Complications ◽

Risk Index ◽

Clinical Importance ◽

Cardiac Risk ◽

Cardiovascular Complications ◽

Improvement Program ◽

Deliberate Hypotension ◽

Number Of Patients

Reducing mortality due to cardiovascular complications (CVC) after non-cardiac surgery is one of the priority tasks of modern healthcare. According to the literature data, it is the CVC that are leading cause of perioperative mortality in non-cardiac surgery. Atrial fibrillation (AF) is a common complication after surgery. It is believed that in most cases the AF is potentiated by a combination of factors. It is intraoperative triggers, such as deliberate hypotension, anemia, injury, and pain, that can directly contribute to development of arrhythmia. However, heart rate monitoring after non-cardiac surgery is performed in only a small number of patients, so in most cases, arrhythmias remain unreported. The Revised Cardiac Risk Index (RCRI) and theAmericanCollegeof Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Surgical Risk Calculator are the current tools for assessing perioperative cardiovascular risk. Postoperative AF is not included in any CVC risk stratification system. The presented review systematizes the data that postoperative AF is closely associated with perioperative complications and in some cases it may be the only marker of these complications. It has been shown that AF detection is of great clinical importance in both high-risk patients and, especially, in patients with a low risk of potential complications in non-cardiac surgery.

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P1395The role of hyponatremia in the development of atrial fibrillation after cardiac surgery

EP Europace ◽

10.1093/europace/euaa162.058 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

A Pavlikova ◽

A Shevelyok ◽

N Vatutin

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Serum Sodium ◽

Sodium Level ◽

Cox Regression ◽

Serum Sodium Level ◽

History Of ◽

The Impact

Abstract 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.

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Cell-Free Circulating Mitochondrial DNA: A Potential Blood-Based Marker for Atrial Fibrillation

Cells ◽

10.3390/cells9051159 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1159 ◽

Cited By ~ 1

Author(s):

Marit Wiersma ◽

Denise M.S. van Marion ◽

Emma J. Bouman ◽

Jin Li ◽

Deli Zhang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Mitochondrial Dna ◽

Cardiac Surgery ◽

Early Recognition ◽

Serum Marker ◽

Therapy Failure ◽

Patients At Risk ◽

History Of ◽

Af Recurrence

Atrial fibrillation (AF), the most common, progressive tachyarrhythmia is associated with serious complications, such as stroke and heart failure. Early recognition of AF, essential to prevent disease progression and therapy failure, is hampered by the lack of accurate diagnostic serum biomarkers to identify the AF stage. As we previously showed mitochondrial dysfunction to drive experimental and human AF, we evaluated whether cell-free circulating mitochondrial DNA (cfc-mtDNA) represents a potential serum marker. Therefore, the levels of two mtDNA genes, COX3 and ND1, were measured in 84 control patients (C), 59 patients undergoing cardiac surgery without a history of AF (SR), 100 paroxysmal (PAF), 116 persistent (PeAF), and 20 longstanding-persistent (LS-PeAF) AF patients undergoing either cardiac surgery or AF treatment (electrical cardioversion or pulmonary vein isolation). Cfc-mtDNA levels were significantly increased in PAF patients undergoing AF treatment, especially in males and patients with AF recurrence after AF treatment. In PeAF and LS-PeAF, cfc-mtDNA levels gradually decreased. Importantly, cfc-mtDNA in serum may originate from cardiomyocytes, as in vitro tachypaced cardiomyocytes release mtDNA in the medium. The findings suggest that cfc-mtDNA is associated with AF stage, especially in males, and with patients at risk for AF recurrence after treatment.

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Abstract 17255: Premature Atrial Stimulation Reveals Increased Conduction Slowing and Block in Cardiac Surgery Patients That Develop Postoperative Atrial Fibrillation

Circulation ◽

10.1161/circ.142.suppl_3.17255 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Muhammad S Khan ◽

Vikas Sharma ◽

Ravi Ranjan ◽

Jason P Glotzbach ◽

Craig Selzman ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Pulmonary Veins ◽

Conduction Block ◽

Postoperative Atrial Fibrillation ◽

Conduction Delay ◽

Epicardial Mapping ◽

Conduction Abnormalities ◽

History Of ◽

Atrial Stimulation

Introduction: Postoperative atrial fibrillation (POAF) is a common cardiac surgery complication that is highly associated with increased morbidity and mortality. The relation of presurgical left atrial (LA) conduction abnormalities and POAF during intraoperative premature atrial stimulation (S1S2) pacing is investigated and reported. Hypothesis: Intraoperative premature atrial stimulation reveals increased areas of slowed or blocked conduction in patients that develop POAF. Methods: High-density intraoperative epicardial mapping was conducted in 20 cardiac surgery patients with no history of preoperative atrial fibrillation (AF) both in sinus rhythm (SR) and during S1S2 pacing. A flexible array comprised of 240 electrodes was placed on the posterior LA wall in between the pulmonary veins. For each patient, the area of conduction block (CB), conduction delay (CD) and combined conduction delay and block (CDCB) for conduction velocity <0.1 m/s, 0.1 - 0.2 m/s and <0.2 m/s, respectively were quantified. Results: In 20 patients, 6 (30%) developed POAF. As shown in the Figure, conduction maps revealed the presence of significantly higher areas of CD (13.2±6.6% vs. 6.1±4.2%, p=0.03) and CDCB (17.5±8.7% vs. 7.4±6.4%, p=0.03), and a trend toward larger CB (4.2±3.8% vs. 1.3±2.9%, p=0.09) in patients that developed POAF for premature atrial beat S2 compared to patients that remained in SR after cardiac surgery. S1 paced beats and SR did not show significant differences in abnormal conduction percentages between patients with and without POAF. Conclusions: Premature atrial stimulation accentuates conduction abnormalities in cardiac surgery patients that develop POAF, revealing a pre-surgical substrate that may indicate greater risk for post-surgical atrial arrhythmias.

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Comparison of Rosuvastatin versus Atorvastatin for Preventing Postoperative Atrial Fibrillation

The Heart Surgery Forum ◽

10.1532/hsf98.20121061 ◽

2013 ◽

Vol 16 (3) ◽

pp. 158 ◽

Cited By ~ 5

Author(s):

Okay Abaci ◽

Cuneyt Kocas ◽

Veysel Oktay ◽

Cenk Eray Yildiz ◽

Kadriye Orta Kilickesmez ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Left Ventricular ◽

Postoperative Atrial Fibrillation ◽

Atorvastatin Treatment ◽

Elective Cardiac Surgery ◽

Increased Risk ◽

History Of ◽

Group 2 ◽

Group 1

Background: Postoperative atrial fibrillation (AF) following cardiac surgery is associated with an increased risk of stroke, prolonged hospitalization, and increased costs. Statin therapy is associated with a lower incidence of postoperative AF. We aimed to compare the preventive effects of rosuvastatin and atorvastatin on postoperative AF.Methods: This study included 168 patients undergoing elective cardiac surgery with cardiopulmonary bypass. Patients were divided into 2 groups according to treatment of statin. Group 1 (n = 96) was patients receiving atorvastatin, and group 2 (n = 72) was patients receiving rosuvastatin. Postoperative electrocardiographs (ECGs) and telemetry strips were examined for AF within postoperative period during hospitalization.Results: The incidences of postoperative AF were 17.9% (n = 17) in group 1 and 22.2% (n = 16) in group 2 (P = .48). Left ventricular end-diastolic diameter (LVEDD) and ejection fraction (EF) were not different between groups. Incidence of diabetes, hypertension, hyperlipidemia, smoking, myocardial infarction in past medical history, family history of atherosclerosis, male sex, drug use, and perioperative features were similar between groups.Conclusions: The present study revealed that preoperative rosuvastatin or atorvastatin treatment did not have a different effect in preventing postoperative AF.

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Pentraxin 3 and other inflammatory biomarkers related to atrial fibrillation in cardiac surgery

Perfusion ◽

10.1177/0267659116679248 ◽

2016 ◽

Vol 32 (4) ◽

pp. 269-278 ◽

Cited By ~ 2

Author(s):

Zdenka Holubcova ◽

Pavel Kunes ◽

Jiri Mandak ◽

Dana Vlaskova ◽

Martina Kolackova ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Serum Levels ◽

Inflammatory Biomarkers ◽

Surgical Patients ◽

Significant Difference ◽

History Of ◽

Group A ◽

Group B ◽

New Onset

Objectives: The aim was to evaluate the association between perioperative inflammatory biomarkers and atrial fibrillation (AF) in cardiac surgical patients. Methods: Forty-two patients undergoing cardiac surgery were divided into three groups according to the occurrence of AF: Group A (n = 22) – patients with no AF, Group B (n = 11) – patients with new onset AF postoperatively and Group C (n = 9) – patients with preoperative history of atrial fibrillation. The serum levels of PTX3, CRP, TLR2, IL-8, IL-18, sFas, MMP-7 and MMP-8 were measured at the following time points: before surgery, immediately and 6 h after surgery and on the 1st, 3rd and 7th postoperative days (POD). Results: Serum levels of PTX3 showed a significant difference between Groups A and C on the 3rd POD (p<0.05) and on the 7th POD (p<0.0001). IL-8 levels were different between Groups A and C immediately after surgery (p<0.05), 6 hours after surgery (p<0.05) and on the 3rd POD (p<0.05). There was a difference between Groups B and C on the 1st POD in IL-8 levels (p<0.05). The sFas levels differed between Groups A and C on the 3rd POD (p<0.01) and the 7th POD (p<0.05). There was also a difference on the 7th POD (p<0.05) between the Groups B and C. No significant differences between the groups was seen for other biomarkers. Conclusion: This study demonstrates significantly different dynamics of PTX3, IL-8 and sFas levels after cardiac surgery in relation to AF.

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Timing of β-Blocker Reintroduction and the Occurrence of Postoperative Atrial Fibrillation after Cardiac Surgery

Anesthesiology ◽

10.1097/aln.0000000000003064 ◽

2020 ◽

Vol 132 (2) ◽

pp. 267-279 ◽

Cited By ~ 4

Author(s):

Camille Couffignal ◽

Julien Amour ◽

Nora Ait-Hamou ◽

Bernard Cholley ◽

Jean-Luc Fellahi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Postoperative Atrial Fibrillation ◽

Secondary Outcome ◽

Outcome Relationship ◽

History Of ◽

Β Blocker ◽

Β Blockers

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background For cardiac surgery patients under chronic β-blocker therapy, guidelines recommend their early postoperative reintroduction to decrease the incidence of postoperative atrial fibrillation. The authors hypothesized that the timing of β-blocker reintroduction affects their effectiveness on the incidence of postoperative atrial fibrillation. Methods This multicenter prospective French cohort study included patients on β-blockers (more than 30 days before surgery) in sinus rhythm without a pacemaker. The primary outcome, time sequence of β-blocker reintroduction, was analyzed for 192 h after surgery. The secondary outcome, relationship between the occurrence of postoperative atrial fibrillation and timing of β-blocker reintroduction, was analyzed based on pre- and intraoperative predictors (full and selected sets) according to landmark times (patients in whom atrial fibrillation occurred before a given landmark time were not analyzed). Results Of 663 patients, β-blockers were reintroduced for 532 (80%) but for only 261 (39%) patients in the first 48 h after surgery. Median duration before reintroduction was 49.5 h (95% CI, 48 to 51.5 h). Postoperative atrial fibrillation or death (N = 4) occurred in 290 (44%) patients. After performing a landmark analysis to take into account the timing of β-blocker reintroduction, the adjusted odds ratios (95% CI) for predictor full and selected (increased age, history of paroxysmal atrial fibrillation, and duration of aortic cross clamping) sets for the occurrence of postoperative atrial fibrillation were: adjusted odds ratio (full) = 0.87 (0.58 to 1.32; P = 0.517) and adjusted odds ratio (selected) = 0.84 (0.58 to 1.21; P = 0.338) at 48 h; adjusted odds ratio (full) = 0.64 (0.39 to 1.05; P = 0.076) and adjusted odds ratio (selected) = 0.58 (0.38 to 0.89; P = 0.013) at 72 h; adjusted odds ratio (full) = 0.58 (0.31 to 1.07; P = 0.079) and adjusted odds ratio (selected) = 0.53 (0.31 to 0.91; P = 0.021) at 96 h. Conclusions β-Blockers were reintroduced early (after less than 48 h) in fewer than half of the cardiac surgery patients. Reintroduction decreased postoperative atrial fibrillation occurrence only at later time points and only in the predictor selected set model. These results are an incentive to optimize (timing, doses, or titration) β-blocker reintroduction after cardiac surgery.

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Abstract 2864: Antiarrhythmic Effect of Statins and Atrial Fibrillation: A Meta-analysis of Randomized Controlled Trials.

Circulation ◽

10.1161/circ.116.suppl_16.ii_637-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Laurent Fauchier ◽

Bertrand Pierre ◽

Caroline Grimard ◽

Axel de Labriolle ◽

Guillaume Breard ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Sinus Rhythm ◽

Randomized Trials ◽

Experimental Studies ◽

Antiarrhythmic Effect ◽

Controlled Trials ◽

Cochrane Central Register ◽

Randomized Controlled ◽

History Of

The use of statins has been suggested to protect against atrial fibrillation (AF) in some clinical and experimental studies but remained inadequately explored. Specifically, observational studies provided evidence supporting a protective role of statins against atrial fibrillation. However, insufficient data are available at this time to allow recommendations for prevention of AF using statins. In order to improve the evaluation of their possible benefit, we performed a metaanalysis of randomized trials with statins on the endpoint of incidence or recurrence of atrial fibrillation. Methods. A systematic review of controlled trials with statins was performed. Data sources included Medline, Embase, Cochrane central register of controlled trials, and hand search. Predefined criteria were used to select controlled clinical trials. Eligible studies had to be randomized, controlled, parallel-design human trials with use of statins that collected data on incidence or recurrence of atrial fibrillation. Data were extracted for patients’ characteristics, interventions, quality of trials, and rates of events. Results. Four studies with 430 patients in sinus rhythm were included in the analysis. Three studies investigated the use of statins in patients with a history of paroxysmal AF (n = 1) or persistent AF after electrical cardioversion (n = 2) and one in primary prevention of AF in patients undergoing cardiac surgery. Coronary artery disease was present in 179/430 patients (42 %). Beta blockers were prescribed in 243/430 (57 %) and amiodarone in 7/430 (1.6 %) of the patients. Incidence or recurrence of atrial fibrillation occurred in 190 patients: 70/216 in patients treated with statin vs 120/214 in controls. Thus, the use of statins was significantly associated with a decreased risk of atrial fibrillation compared to control (relative risk 0.37, 95% confidence interval 0.25 to 0.55, p < 0.0001). Conclusions. In randomized trials, use of statins in patients in sinus rhythm with a history of previous AF or undergoing cardiac surgery was significantly associated with a decreased risk of incidence or recurrence of atrial fibrillation.

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