Meta-Analysis

. 2021 Jul;68(7):1045-1056.

doi: 10.1007/s12630-021-01944-0. Epub 2021 Feb 23.

Incidence and recurrence of new-onset atrial fibrillation detected during hospitalization for non-cardiac surgery: a systematic review and meta-analysis

William F McIntyre^{1

2

3}, Maria E Vadakken⁴, Anand S Rai⁴, Terry Thach⁵, Wajahat Syed⁵, Kevin J Um⁶, Omar Ibrahim⁶, Shreyash Dalmia⁶, Akash Bhatnagar⁴, Pablo A Mendoza⁷, Alexander P Benz^{4

7}, Shrikant I Bangdiwala^{4

7}, Jessica Spence^{4

6

7}, Graham R McClure⁸, Jessica T Huynh⁶, Tianyi Zhang⁴, Toru Inami⁹, David Conen^{4

6

7}, P J Devereaux^{4

6

7}, Richard P Whitlock^{4

6

8}, Jeff S Healey^{4

6

7}, Emilie P Belley-Côté^{4

6}

Affiliations

¹ Population Health Research Institute, McMaster University, Hamilton, ON, Canada. William.McIntyre@phri.ca.
² Department of Medicine, McMaster University, Hamilton, ON, Canada. William.McIntyre@phri.ca.
³ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. William.McIntyre@phri.ca.
⁴ Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
⁵ Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
⁶ Department of Medicine, McMaster University, Hamilton, ON, Canada.
⁷ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
⁸ Department of Surgery, McMaster University, Hamilton, ON, Canada.
⁹ Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.

PMID: 33624255
DOI: 10.1007/s12630-021-01944-0

Meta-Analysis

Incidence and recurrence of new-onset atrial fibrillation detected during hospitalization for non-cardiac surgery: a systematic review and meta-analysis

William F McIntyre et al. Can J Anaesth. 2021 Jul.

. 2021 Jul;68(7):1045-1056.

doi: 10.1007/s12630-021-01944-0. Epub 2021 Feb 23.

Authors

Affiliations

¹ Population Health Research Institute, McMaster University, Hamilton, ON, Canada. William.McIntyre@phri.ca.
² Department of Medicine, McMaster University, Hamilton, ON, Canada. William.McIntyre@phri.ca.
³ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. William.McIntyre@phri.ca.
⁴ Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
⁵ Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
⁶ Department of Medicine, McMaster University, Hamilton, ON, Canada.
⁷ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
⁸ Department of Surgery, McMaster University, Hamilton, ON, Canada.
⁹ Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.

PMID: 33624255
DOI: 10.1007/s12630-021-01944-0

Abstract
in English, French

Purpose: This systematic review aimed to summarize reports of the incidence and long-term recurrence of new-onset atrial fibrillation (AF) associated with non-cardiac surgery.

Sources: We searched CENTRAL, MEDLINE and EMBASE from inception to November 2019. We included studies that reported on the incidence of new-onset perioperative AF during hospitalization for non-cardiac surgery and/or AF recurrence in such patients following discharge. Reviewers screened articles and abstracted data independently and in duplicate. We assessed study quality by appraising methodology for collecting AF history, incident AF during hospitalization, and AF recurrence after discharge.

Principal findings: From 39,233 citations screened, 346 studies that enrolled a total of 5,829,758 patients met eligibility criteria. Only 27 studies used prospective, continuous inpatient electrocardiographic (ECG) monitoring to detect incident AF. Overall, the incidence of postoperative AF during hospitalization ranged from 0.004 to 50.3%, with a median [interquartile range] of 8.7 [3.8-15.0]%. Atrial fibrillation incidence varied with type of surgery. Prospective studies using continuous ECG monitoring reported significantly higher incidences of AF than those that did not (13.9% vs 1.9%, respectively; P < 0.001). A total of 13 studies (25,726 patients) with follow-up up to 5.4 years reported on AF recurrence following hospital discharge; only one study used a prospective systematic monitoring protocol. Recurrence rates ranged from 0 to 37.3%.

Conclusions: Rates of AF incidence first detected following non-cardiac surgery and long-term AF recurrence vary markedly. Differences in the intensity of ECG monitoring and type of surgery may account for this variation.

Trial registration: PROSPERO (CRD42017068055); registered 1 September 2017.

RéSUMé: OBJECTIF: Cette revue systématique visait à résumer les comptes rendus sur l’incidence et la récurrence à long terme de la fibrillation auriculaire (FA) de novo associée à une chirurgie non cardiaque.

Sources: Nous avons effectué des recherches dans les bases de données CENTRAL, MEDLINE et EMBASE de leur création à novembre 2019. Nous avons inclus les études ayant examiné l’incidence de nouvelle FA périopératoire pendant l’hospitalisation pour une chirurgie non cardiaque et/ou la récurrence de la FA chez de tels patients après leur congé. Les chercheurs ont passé en revue les articles et les données extraites de manière indépendante et en double. Nous avons estimé la qualité des études en évaluant la méthodologie de collecte des antécédents de FA, de l’incident de FA pendant l’hospitalisation et de la récurrence de FA après le congé.

Constatations principales: Sur les 39 233 citations examinées, 346 études portant sur un total de 5 829 758 patients ont répondu à nos critères d’admissibilité. Seulement 27 études ont utilisé un monitorage électrocardiographique (ECG) continu prospectif et des patients hospitalisés pour détecter les incidents de FA. Dans l’ensemble, l’incidence de FA postopératoire pendant l’hospitalisation allait de 0,004 à 50,3 %, avec une médiane [écart interquartile] de 8,7 [3,8-15,0] %. L’incidence de fibrillation auriculaire variait en fonction du type de chirurgie. Des études prospectives utilisant un monitorage continu par ECG ont fait état d’incidences significativement plus élevées de FA que celles sans monitorage continu (13,9 % vs 1,9 %, respectivement; P < 0,001). Au total, 13 études (25 726 patients) avec un suivi allant jusqu’à 5,4 ans ont rapporté leurs données sur la récurrence de FA après le congé de l’hôpital; seule une étude a utilisé un protocole de monitorage prospectif systématique. Les taux de récurrence allaient de 0 à 37,3 %.

Conclusion: Les taux d’incidence de nouvelle FA détectés après une chirurgie non cardiaque et la récurrence à long terme de FA varient considérablement. Les différences du degré de monitorage par ECG et le type de chirurgie pourraient expliquer cette variation. ENREGISTREMENT DE L’éTUDE: PROSPERO (CRD42017068055); enregistrée le 1er septembre 2017.

Keywords: atrial fibrillation; perioperative; reversible; secondary; stroke; telemetry.

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References

1. Lloyd-Jones DM, Wang TJ, Leip EP, et al. Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation 2004; 110: 1042-6. - DOI
1. McIntyre WF, Connolly SJ, Healey JS. Atrial fibrillation occurring transiently with stress. Curr Opin Cardiol 2018; 33: 58-65. - DOI
1. McIntyre WF, Um KJ, Alhazzani W, et al. Association of vasopressin plus catecholamine vasopressors versus catecholamines alone with atrial fibrillation in patients with distributive shock: a systematic review and meta-analysis. JAMA 2018; 319: 889-900. - DOI
1. McIntyre WF, Um KJ, Cheung CC, et al. Atrial fibrillation detected initially during acute medical illness: a systematic review. Eur Heart J Acute Cardiovasc Care 2019; 8: 130-41. - DOI
1. Bhave PD, Goldman LE, Vittinghoff E, Maselli J, Auerbach A. Incidence, predictors, and outcomes associated with postoperative atrial fibrillation after major noncardiac surgery. Am Heart J 2012; 164: 918-24. - DOI

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Incidence and recurrence of new-onset atrial fibrillation detected during hospitalization for non-cardiac surgery: a systematic review and meta-analysis

Affiliations

Incidence and recurrence of new-onset atrial fibrillation detected during hospitalization for non-cardiac surgery: a systematic review and meta-analysis

Authors

Affiliations

Abstract
in English, French

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Miscellaneous

Abstract in English, French

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Miscellaneous

Abstract
in English, French