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. 2011 Feb;141(2):559-70.
doi: 10.1016/j.jtcvs.2010.03.011.

The persistent problem of new-onset postoperative atrial fibrillation: a single-institution experience over two decades

Jeanne Shen  1 , Shelly Lall, Victoria Zheng, Patricia Buckley, Ralph J Damiano Jr, Richard B Schuessler
Affiliations

The persistent problem of new-onset postoperative atrial fibrillation: a single-institution experience over two decades

Jeanne Shen et al. J Thorac Cardiovasc Surg. 2011 Feb.

Abstract

Objective: Postoperative atrial fibrillation is the most common complication after cardiac surgery. A variety of postoperative atrial fibrillation risk factors have been reported, but study results have been inconsistent or contradictory, particularly in patients with preexisting atrial fibrillation. The incidence of postoperative atrial fibrillation was evaluated in a group of 10,390 patients undergoing cardiac surgery among a comprehensive range of risk factors to identify reliable predictors of postoperative atrial fibrillation.

Methods: This 20-year retrospective study examined the relationship between postoperative atrial fibrillation and demographic factors, preoperative health conditions and medications, operative procedures, and postoperative complications. Multivariate logistic regression models were used to evaluate potential predictors of postoperative atrial fibrillation.

Results: Increasing age, mitral valve surgery (odds ratio=1.91), left ventricular aneurysm repair (odds ratio=1.57), aortic valve surgery (odds ratio=1.52), race (Caucasian) (odds ratio=1.51), use of cardioplegia (odds ratio=1.36), use of an intraaortic balloon pump (odds ratio=1.28), previous congestive heart failure (odds ratio=1.28), and hypertension (odds ratio=1.15) were significantly associated with postoperative atrial fibrillation. The non-linear relationship between age and postoperative atrial fibrillation revealed the acceleration of postoperative atrial fibrillation risk in patients aged 55 years or more. In patients undergoing coronary artery bypass grafting, increasing age and previous congestive heart failure were the only factors associated with a higher risk of postoperative atrial fibrillation. There was no trend in incidence of postoperative atrial fibrillation over time. No protective factors against postoperative atrial fibrillation were detected, including commonly prescribed categories of medications.

Conclusions: The persistence of the problem of postoperative atrial fibrillation and the modest predictability using common risk factors suggest that limited progress has been made in understanding its cause and treatment.

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Figures

Figure 1
Figure 1
Incidence of new onset POAF for all patients and only CABG patients over a 20-year period.
Figure 2
Figure 2
Estimated probability of POAF by age.
Figure 3
Figure 3
Figure 3A: Trends in type of operation. MV: mitral valve procedure. AV: aortic valve procedure. CABG: coronary artery bypass graft procedure. Figure 3B: Trend in congestive heart failure (CHF). Figure 3C: Trend in hypertension. Figure 3D: Trend in the use of cardioplegia.
Figure 3
Figure 3
Figure 3A: Trends in type of operation. MV: mitral valve procedure. AV: aortic valve procedure. CABG: coronary artery bypass graft procedure. Figure 3B: Trend in congestive heart failure (CHF). Figure 3C: Trend in hypertension. Figure 3D: Trend in the use of cardioplegia.
Figure 3
Figure 3
Figure 3A: Trends in type of operation. MV: mitral valve procedure. AV: aortic valve procedure. CABG: coronary artery bypass graft procedure. Figure 3B: Trend in congestive heart failure (CHF). Figure 3C: Trend in hypertension. Figure 3D: Trend in the use of cardioplegia.
Figure 3
Figure 3
Figure 3A: Trends in type of operation. MV: mitral valve procedure. AV: aortic valve procedure. CABG: coronary artery bypass graft procedure. Figure 3B: Trend in congestive heart failure (CHF). Figure 3C: Trend in hypertension. Figure 3D: Trend in the use of cardioplegia.
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