Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2025 Jun 18;20(1):265.
doi: 10.1186/s13019-025-03504-9.

Early postoperative atrial fibrillation is associated with late mortality after cardiac surgery: a systematic review and reconstructed individual patient data meta-analysis

Michal J Kawczynski #  1   2   3 , Claudia A J van der Heijden #  4 , Jos G Maessen  1   3 , Ulrich Schotten  2   3 , Mariusz Kowalewski  3   5 , Piotr Suwalski  5 , Elham Bidar #  1   3 , Bart Maesen #  6   7
Affiliations
Meta-Analysis

Early postoperative atrial fibrillation is associated with late mortality after cardiac surgery: a systematic review and reconstructed individual patient data meta-analysis

Michal J Kawczynski et al. J Cardiothorac Surg. .

Abstract

Background: Early postoperative atrial fibrillation (early-POAF) is the most common complication after cardiac surgery. Although prior studies have demonstrated an association between early-POAF and late outcomes, it is questionable whether these long-term adverse events result from early-POAF or from comorbidities that underlie the development of early-POAF. Therefore, the aim of this study was to investigate the association of early-POAF with late mortality and stroke after adjustment for age and cardiovascular comorbidities.

Methods: A systematic search was conducted to identify studies reporting on late mortality after cardiac surgery in patients with and without early-POAF. Articles presenting Kaplan-Meier were included for a pooled analysis of late mortality (primary outcome) and stroke (secondary outcome). Individual time-to-event data were reconstructed from the Kaplan-Meier curves and incorporated into a multivariable mixed-effects Cox model.

Results: In total, 33 studies were included in the analysis for late mortality (131 031 patients) and 10 studies in the analysis for late stroke (42 042 patients). Overall, 36 991 patients had early-POAF with a pooled incidence of 31.5% (95% CI: 27.7 to 35.6%). Unadjusted analysis showed that early-POAF was significantly associated with late mortality (Hazard Ratio [HR] = 1.62, 95%CI: 1.58-1.67, P < 0.001) and late stroke (HR = 1.72, 95%CI: 1.61-1.85, P < 0.001). Early-POAF was significantly associated with late mortality (adjusted HR = 1.19, 95% CI: 1.07-1.33, P = 0.002), but not with late stroke (adjusted HR = 1.14, 95% CI: 0.96-1.35, P = 0.122) after adjustment for age, comorbidities, surgery type, and the random effects term.

Conclusion: Early-POAF after cardiac surgery is significantly associated with late mortality, but not with late stroke, after adjustments for age, sex, cardiovascular comorbidities, and type of surgery.

Keywords: Cardiac surgery; Long-term outcomes; Meta-analysis; Postoperative atrial fibrillation.

PubMed Disclaimer

Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study inclusion diagram
Fig. 2
Fig. 2
Hazard plots for late mortality and late stroke. A. Unadjusted late mortality in patients with and without POAF. B. Unadjusted late stroke in patients with and without POAF
Fig. 3
Fig. 3
Hazard plots for late mortality and late stroke for different surgical procedures. A Unadjusted late mortality hazard in patients with and without POAF undergoing CABG. B Unadjusted late mortality hazard in patients with and without POAF undergoing other cardiac procedures. C Unadjusted late stroke hazard in patients with and without POAF undergoing CABG. D Unadjusted late stroke hazard in patients with and without POAF undergoing other cardiac procedures
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Maesen B, Nijs J, Maessen J, Allessie M, Schotten U. Post-operative atrial fibrillation: a maze of mechanisms. Europace. 2012;14:159–74. - PMC - PubMed
    1. Dobrev D, Aguilar M, Heijman J, Guichard JB, Nattel S. Postoperative atrial fibrillation: mechanisms, manifestations and management. Nat Rev Cardiol. 2019;16:417–36. - PubMed
    1. Lin MH, Kamel H, Singer DE, Wu YL, Lee M, Ovbiagele B. Perioperative/Postoperative Atrial Fibrillation and Risk of Subsequent Stroke and/or Mortality. Stroke. 2019;50(6):1364–71. - PubMed
    1. Eikelboom R, Sanjanwala R, Le ML, Yamashita MH, Arora RC. Postoperative Atrial Fibrillation After Cardiac Surgery: A Systematic Review and Meta-Analysis. Ann Thorac Surg. 2021;111(2):544–54. - PubMed
    1. Caldonazo T, Kirov H, Rahouma M, Robinson NB, Demetres M, Gaudino M, et al. Atrial fibrillation after cardiac surgery: A systematic review and meta-analysis. J Thorac Cardiovasc Surg. 2023;165(1):94-103.e24. - PubMed

MeSH terms

LinkOut - more resources