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Thorac Cardiovasc Surg 2019; 67(02): 107-116
DOI: 10.1055/s-0038-1667065
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Clinical Risk Factors for Postoperative Atrial Fibrillation among Patients after Cardiac Surgery

Kennosuke Yamashita   *
1   Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, United States
2   Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States
,
Nan Hu   *
3   Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States
4   Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States
,
Ravi Ranjan
1   Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, United States
2   Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States
,
Craig H. Selzman
1   Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, United States
5   Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, United States
,
Derek J. Dosdall
1   Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah, United States
2   Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States
5   Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, United States
› Author Affiliations
Further Information

Publication History

12 April 2018

07 June 2018

Publication Date:
02 August 2018 (online)

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Abstract

Background Postoperative atrial fibrillation (POAF) is a common arrhythmia following cardiac surgery and is associated with increased health-care costs, complications, and mortality. The etiology of POAF is incompletely understood and its prediction remains suboptimal. Using data from published studies, we performed a systemic review and meta-analysis to identify preoperative clinical risk factors associated with patients at increased risk of POAF.

Methods A systematic search of PubMed, MEDLINE, and EMBASE databases was performed.

Results Twenty-four studies that reported univariate analysis results regarding POAF risk factors, published from 2001 to May 2017, were included in this meta-analysis with a total number of 36,834 subjects. Eighteen studies were performed in the United States and Europe and 16 studies were prospective cohort studies. The standardized mean difference (SMD) between POAF and non-POAF groups was significantly different (reported as [SMD: 95% confidence interval, CI]) for age (0.55: 0.47–0.63), left atrial diameter (0.45: 0.15–0.75), and left ventricular ejection fraction (0.30: 0.14–0.47). The pooled odds ratios (ORs) (reported as [OR: 95% CI]) demonstrated that heart failure (1.56: 1.31–1.96), chronic obstructive pulmonary disease (1.36: 1.13–1.64), hypertension (1.29: 1.12–1.48), and myocardial infarction (1.18: 1.05–1.34) were significant predictors of POAF incidence, while diabetes was marginally significant (1.06: 1.00–1.13).

Conclusion The present analysis suggested that older age and history of heart failure were significant risk factors for POAF consistently whether the included studies were prospective or retrospective datasets.

Keywords

atrial fibrillation - cardiac surgery - odds ratios - standardized mean difference

Note

This paper has been presented at the American College of Cariology's 67th Annual Scientific Session & Expo in Orlando, taking place from March 10th to 12th. Journal of the American College of Cardiology, Volume 71, Issue 11, Supplement, 10–12 March 2018, Page a371.


Author Contributions

(1) KY, NH, and DD devised the study design and conception. KY, NH, and DD analyzed and interpreted data.


(2) KY, NH, and DD drafted the manuscript and CC, RR, NH, and DD revised it critically.


(3) All authors approved the final version of the manuscript.


* Both authors contributed equally to the manuscript.