Identifying at-risk patients to minimize complications

March 15, 2023

Postoperative atrial fibrillation (POAF) is one of the most common complications after cardiac surgery, with an incidence range of 20% to 50%. POAF is associated with a longer hospital stay, higher health care resource use, and higher risk of morbidity and mortality.

Most of the available data on the incidence, risk factors and prognostic implications of POAF have been acquired from studies of patients undergoing coronary artery bypass graft and left-sided valve surgery. There are limited data in adults with congenital heart disease (CHD), which is a knowledge gap in need of further exploration, as the majority of adults with CHD will require cardiac surgery in their lifetimes.

A retrospective study was conducted among adults with CHD who underwent cardiac surgery using cardiopulmonary bypass at Mayo Clinic in Rochester, Minnesota, between January 1, 2003, and December 31, 2019. The results were published in the November 2022 issue of JACC: Clinical Electrophysiology.

"The study was conducted to determine how common atrial fibrillation (AF) was after cardiac surgery in adults with CHD, and to identify the subset of patients at the highest risk of developing AF after cardiac surgery," says Alexander C. Egbe, M.B.B.S., M.P.H., a cardiologist at Mayo Clinic in Rochester and first author of the study.

POAF and late-onset AF were defined as AF occurring within and after 30 days postoperatively, respectively. Of the 1,598 patients studied, 20.9% developed POAF. Of the 335 patients with POAF, 94% developed POAF prior to hospital discharge. The median interval between surgery and onset of POAF was three days.

By identifying the risk factors associated with POAF — older age, hypertension, left atrial reservoir strain, right atrial reservoir strain and nonsystemic atrioventricular valve regurgitation — on the basis of multivariable analysis, this study provides a foundation for prospective studies assessing the efficacy of prophylactic therapies in this population.

"By incorporating the knowledge of these risk factors into our practice, we can identify patients at higher risk of complications, and upstream management can be considered to minimize the occurrence of POAF," says Abhishek J. Deshmukh, M.B.B.S., a cardiologist at Mayo Clinic in Rochester, Minnesota, and senior author of the study.

For more information

Egbe AC, et al. Outcome of new-onset postoperative atrial fibrillation after cardiac surgery in adults with congenital heart disease. JACC: Clinical Electrophysiology. 2022;8:1407.

Mayo Clinic Cardiovascular Diseases and Cardiac Surgery

Refer a patient to Mayo Clinic.