Atrial Fibrillation after Cardiac Surgery – A Systematic Review and Meta-Analysis

ABSTRACT Objective New-onset post-operative atrial fibrillation (POAF) after cardiac surgery is common, with rates up to 60%. POAF has been associated with early and late stroke, but its association with other cardiovascular outcomes is less known. The objective was to perform a meta-analysis of the studies reporting the association of POAF with peri-operative and long-term outcomes in cardiac surgery. Methods We performed a systematic review and a meta-analysis of studies presenting outcomes for cardiac surgery based on the presence or absence of POAF. MEDLINE, EMBASE and Cochrane Library were assessed, 57 studies (246,340 patients) were selected. Peri-operative mortality was the primary outcome. Inverse variance method and random model were performed. Leave-one-out analysis, sub-group analyses and meta-regression were conducted. Results POAF was associated with peri-operative mortality (odds ratio [OR]= 1.92, 95% confidence interval [CI] 1.58; 2.33), peri-operative stroke (OR= 2.17, 95% CI 1.90; 2.49), peri-operative myocardial infarction (OR= 1.28, 95% CI 1.06; 1.54), peri-operative acute renal failure (OR= 2.74, 95% CI 2.42; 3.11), hospital (standardized mean difference [SMD]= 0.80, 95% CI 0.53; 1.07) and ICU stay (SMD= 0.55, 95% CI 0.24; 0.86), long-term mortality (incidence rate ratio [IRR]= 1.54, 95% CI 1.40; 1.69), long-term stroke (IRR= 1.33, 95% CI 1,21;1,46) and long-standing persistent atrial fibrillation (IRR= 4.73, 95% CI 3.36; 6.66). Conclusion The results suggest that POAF in cardiac surgery is associated with an increased occurrence of most short and long-term cardiovascular adverse events. However, the causality of this association remains to be established.