Perioperative management of new-onset atrial fibrillation after cardiac surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Xiaoyi ¹ , ZHAO Yan ² ,  ZHENG Zhe ¹

1. Department of Cardiovascular Surgery, Fuwai Hospital, Beijing Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100037, P.R.China;
2. National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, Beijing Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100037, P.R.China;

Corresponding author：

ZHENG Zhe, Email: zhengzhe@fuwai.com

Keywords：

Heart; perioperation; atrial fibrillation; surgery; complications; review

DOI：

10.7507/1007-4848.201908060

Video：

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New-onset atrial fibrillation (NOAF) is the most common complication after cardiac surgery. Postoperative atrial fibrillation is traditionally believed to a benign arrhythmia secondary to inflammation or surgical stimulation. However, a number of studies showed that patients with NOAF had a substantially increased adverse cardiovascular events. Therefore, effective treatment is of great significance. This study aims to review recent research of the perioperative management of NOAF.

Citation： WANG Xiaoyi, ZHAO Yan, ZHENG Zhe. Perioperative management of new-onset atrial fibrillation after cardiac surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(6): 700-703. doi: 10.7507/1007-4848.201908060 Copy

1.	Izhar U, Ad N, Rudis E, et al. When should we discontinue antiarrhythmic therapy for atrial fibrillation after coronary artery bypass grafting? A prospective randomized study. J Thorac Cardiovasc Surg, 2005, 129(2): 401-406.
2.	Melduni RM, Schaff HV, Bailey KR, et al. Implications of new-onset atrial fibrillation after cardiac surgery on long-term prognosis: a community-based study. Am Heart J, 2015, 170(4): 659-668.
3.	Lapar DJ, Speir AM, Crosby IK, et al. Postoperative atrial fibrillation significantly increases mortality, hospital readmission, and hospital costs. Ann Thorac Surg, 2014, 98(2): 527-533.
4.	Saxena A, Dinh DT, Smith JA, et al. Usefulness of postoperative atrial fibrillation as an independent predictor for worse early and late outcomes after isolated coronary artery bypass grafting (multicenter Australian study of 19, 497 patients). Am J Cardiol, 2012, 109(2): 219-225.
5.	Gialdini G, Nearing K, Bhave PD, et al. Perioperative atrial fibrillation and the long-term risk of ischemic stroke. JAMA, 2014, 312(6): 616-622.
6.	Verma A, Bhatt DL, Verma S. Long-term outcomes of post-operative atrial fibrillation: guilty as charged. J Am Coll Cardiol, 2018, 71(7): 749-751.
7.	Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J, 2019, 40(2): 87-165.
8.	Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J, 2016, 37(38): 2893-2962.
9.	Funk M, Richards SB, Desjardins J, et al. Incidence, timing, symptoms, and risk factors for atrial fibrillation after cardiac surgery. Am J Crit Care, 2003, 12(5): 424-433.
10.	Shen J, Lall S, Zheng V, et al. The persistent problem of new-onset postoperative atrial fibrillation: a single-institution experience over two decades. J Thorac Cardiovasc Surg, 2011, 141(2): 559-570.
11.	Mathew JP, Parks R, Savino JS, et al. Atrial fibrillation following coronary artery bypass graft surgery: predictors, outcomes, and resource utilization. MultiCenter Study of Perioperative Ischemia Research Group. JAMA, 1996, 276(4): 300-306.
12.	Jeganathan J, Saraf R, Mahmood F, et al. Mitochondrial dysfunction in atrial tissue of patients developing postoperative atrial fibrillation. Ann Thorac Surg, 2017, 104(5): 1547-1555.
13.	Zaman JA, Harling L, Ashrafian H, et al. Post-operative atrial fibrillation is associated with a pre-existing structural and electrical substrate in human right atrial myocardium. Int J Cardiol, 2016, 220: 580-588.
14.	Reilly SN, Jayaram R, Nahar K, et al. Atrial sources of reactive oxygen species vary with the duration and substrate of atrial fibrillation: implications for the antiarrhythmic effect of statins. Circulation, 2011, 124(10): 1107-1117.
15.	Arsenault KA, Yusuf AM, Crystal E, et al. Interventions for preventing post-operative atrial fibrillation in patients undergoing heart surgery. Cochrane Database Syst Rev, 2013, 1: CD003611.
16.	Burgess DC, Kilborn MJ, Keech AC. Interventions for prevention of post-operative atrial fibrillation and its complications after cardiac surgery: a meta-analysis. Eur Heart J, 2006, 27(23): 2846-2857.
17.	Auer J, Weber T, Berent R, et al. A comparison between oral antiarrhythmic drugs in the prevention of atrial fibrillation after cardiac surgery: the pilot study of prevention of postoperative atrial fibrillation (SPPAF), a randomized, placebo-controlled trial. Am Heart J, 2004, 147(4): 636-643.
18.	Maack C, Kartes T, Kilter H, et al. Oxygen free radical release in human failing myocardium is associated with increased activity of rac1-GTPase and represents a target for statin treatment. Circulation, 2003, 108(13): 1567-1574.
19.	Zhen-Han L, Rui S, Dan C, et al. Perioperative statin administration with decreased risk of postoperative atrial fibrillation, but not acute kidney injury or myocardial infarction: A meta-analysis. Sci Rep, 2017, 7(1): 10091.
20.	Zheng Z, Jayaram R, Jiang L, et al. Perioperative rosuvastatin in cardiac surgery. N Engl J Med, 2016, 374(18): 1744-1753.
21.	Dieleman JM, Nierich AP, Rosseel PM, et al. Intraoperative high-dose dexamethasone for cardiac surgery: a randomized controlled trial. JAMA, 2012, 308(17): 1761-1767.
22.	Zhang B, Zhen Y, Tao A, et al. Polyunsaturated fatty acids for the prevention of atrial fibrillation after cardiac surgery: an updated meta-analysis of randomized controlled trials. J Cardiol, 2014, 63(1): 53-59.
23.	Hu XL, Chen Y, Zhou ZD, et al. Posterior pericardiotomy for the prevention of atrial fibrillation after coronary artery bypass grafting: a meta-analysis of randomized controlled trials. Int J Cardiol, 2016, 215: 252-256.
24.	St-Onge S, Ben Ali W, Bouhout I, et al. Examining the impact of active clearance of chest drainage catheters on postoperative atrial fibrillation. J Thorac Cardiovasc Surg, 2017, 154(2): 501-508.
25.	Calkins H. Is less more for the treatment of atrial fibrillation after cardiac surgery? N Engl J Med, 2016, 374(20): 1977-1978.
26.	Echahidi N, Pibarot P, O'hara G, et al. Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery. J Am Coll Cardiol, 2008, 51(8): 793-801.
27.	Al-Khatib SM, Hafley G, Harrington RA, et al. Patterns of management of atrial fibrillation complicating coronary artery bypass grafting: Results from the PRoject of Ex-vivo Vein graft ENgineering via Transfection Ⅳ (PREVENT-Ⅳ) Trial. Am Heart J, 2009, 158(5): 792-798.
28.	Gillinov AM, Bagiella E, Moskowitz AJ, et al. Rate control versus rhythm control for atrial fibrillation after cardiac surgery. N Engl J Med, 2016, 374(20): 1911-1921.
29.	Dobrev D, Aguilar M, Heijman J, et al. Postoperative atrial fibrillation: mechanisms, manifestations and management. Nat Rev Cardiol, 2019, 16(7): 417-436.
30.	Andrade JG, Verma A, Mitchell LB, et al. 2018 focused update of the Canadian Cardiovascular Society guidelines for the management of atrial fibrillation. Can J Cardiol, 2018, 34(11): 1371-1392.
31.	Lin MH, Kamel H, Singer DE, et al. Perioperative/postoperative atrial fibrillation and risk of subsequent stroke and/or mortality. Stroke, 2019, 50(6): 1364-1371.
32.	Megens MR, Churilov L, Thijs V. New-onset atrial fibrillation after coronary artery bypass graft and long-term risk of stroke: a meta-analysis. J Am Heart Assoc, 2017, 6(12): e007558.
33.	Friberg L, Rosenqvist M, Lip GY. Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish atrial fibrillation cohort study. Eur Heart J, 2012, 33(12): 1500-1510.
34.	Butt JH, Xian Y, Peterson ED, et al. Long-term thromboembolic risk in patients with postoperative atrial fibrillation after coronary artery bypass graft surgery and patients with nonvalvular atrial fibrillation. JAMA Cardiol, 2018, 3(5): 417-424.
35.	Crystal A, Freitas C, Yu B, et al. New onset peri-operative atrial fibrillation after coronary artery bypass graft (CABG) surgery. Circulation, 2018, 138: A13249.

1. Izhar U, Ad N, Rudis E, et al. When should we discontinue antiarrhythmic therapy for atrial fibrillation after coronary artery bypass grafting? A prospective randomized study. J Thorac Cardiovasc Surg, 2005, 129(2): 401-406.
2. Melduni RM, Schaff HV, Bailey KR, et al. Implications of new-onset atrial fibrillation after cardiac surgery on long-term prognosis: a community-based study. Am Heart J, 2015, 170(4): 659-668.
3. Lapar DJ, Speir AM, Crosby IK, et al. Postoperative atrial fibrillation significantly increases mortality, hospital readmission, and hospital costs. Ann Thorac Surg, 2014, 98(2): 527-533.
4. Saxena A, Dinh DT, Smith JA, et al. Usefulness of postoperative atrial fibrillation as an independent predictor for worse early and late outcomes after isolated coronary artery bypass grafting (multicenter Australian study of 19, 497 patients). Am J Cardiol, 2012, 109(2): 219-225.
5. Gialdini G, Nearing K, Bhave PD, et al. Perioperative atrial fibrillation and the long-term risk of ischemic stroke. JAMA, 2014, 312(6): 616-622.
6. Verma A, Bhatt DL, Verma S. Long-term outcomes of post-operative atrial fibrillation: guilty as charged. J Am Coll Cardiol, 2018, 71(7): 749-751.
7. Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J, 2019, 40(2): 87-165.
8. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J, 2016, 37(38): 2893-2962.
9. Funk M, Richards SB, Desjardins J, et al. Incidence, timing, symptoms, and risk factors for atrial fibrillation after cardiac surgery. Am J Crit Care, 2003, 12(5): 424-433.
10. Shen J, Lall S, Zheng V, et al. The persistent problem of new-onset postoperative atrial fibrillation: a single-institution experience over two decades. J Thorac Cardiovasc Surg, 2011, 141(2): 559-570.
11. Mathew JP, Parks R, Savino JS, et al. Atrial fibrillation following coronary artery bypass graft surgery: predictors, outcomes, and resource utilization. MultiCenter Study of Perioperative Ischemia Research Group. JAMA, 1996, 276(4): 300-306.
12. Jeganathan J, Saraf R, Mahmood F, et al. Mitochondrial dysfunction in atrial tissue of patients developing postoperative atrial fibrillation. Ann Thorac Surg, 2017, 104(5): 1547-1555.
13. Zaman JA, Harling L, Ashrafian H, et al. Post-operative atrial fibrillation is associated with a pre-existing structural and electrical substrate in human right atrial myocardium. Int J Cardiol, 2016, 220: 580-588.
14. Reilly SN, Jayaram R, Nahar K, et al. Atrial sources of reactive oxygen species vary with the duration and substrate of atrial fibrillation: implications for the antiarrhythmic effect of statins. Circulation, 2011, 124(10): 1107-1117.
15. Arsenault KA, Yusuf AM, Crystal E, et al. Interventions for preventing post-operative atrial fibrillation in patients undergoing heart surgery. Cochrane Database Syst Rev, 2013, 1: CD003611.
16. Burgess DC, Kilborn MJ, Keech AC. Interventions for prevention of post-operative atrial fibrillation and its complications after cardiac surgery: a meta-analysis. Eur Heart J, 2006, 27(23): 2846-2857.
17. Auer J, Weber T, Berent R, et al. A comparison between oral antiarrhythmic drugs in the prevention of atrial fibrillation after cardiac surgery: the pilot study of prevention of postoperative atrial fibrillation (SPPAF), a randomized, placebo-controlled trial. Am Heart J, 2004, 147(4): 636-643.
18. Maack C, Kartes T, Kilter H, et al. Oxygen free radical release in human failing myocardium is associated with increased activity of rac1-GTPase and represents a target for statin treatment. Circulation, 2003, 108(13): 1567-1574.
19. Zhen-Han L, Rui S, Dan C, et al. Perioperative statin administration with decreased risk of postoperative atrial fibrillation, but not acute kidney injury or myocardial infarction: A meta-analysis. Sci Rep, 2017, 7(1): 10091.
20. Zheng Z, Jayaram R, Jiang L, et al. Perioperative rosuvastatin in cardiac surgery. N Engl J Med, 2016, 374(18): 1744-1753.
21. Dieleman JM, Nierich AP, Rosseel PM, et al. Intraoperative high-dose dexamethasone for cardiac surgery: a randomized controlled trial. JAMA, 2012, 308(17): 1761-1767.
22. Zhang B, Zhen Y, Tao A, et al. Polyunsaturated fatty acids for the prevention of atrial fibrillation after cardiac surgery: an updated meta-analysis of randomized controlled trials. J Cardiol, 2014, 63(1): 53-59.
23. Hu XL, Chen Y, Zhou ZD, et al. Posterior pericardiotomy for the prevention of atrial fibrillation after coronary artery bypass grafting: a meta-analysis of randomized controlled trials. Int J Cardiol, 2016, 215: 252-256.
24. St-Onge S, Ben Ali W, Bouhout I, et al. Examining the impact of active clearance of chest drainage catheters on postoperative atrial fibrillation. J Thorac Cardiovasc Surg, 2017, 154(2): 501-508.
25. Calkins H. Is less more for the treatment of atrial fibrillation after cardiac surgery? N Engl J Med, 2016, 374(20): 1977-1978.
26. Echahidi N, Pibarot P, O'hara G, et al. Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery. J Am Coll Cardiol, 2008, 51(8): 793-801.
27. Al-Khatib SM, Hafley G, Harrington RA, et al. Patterns of management of atrial fibrillation complicating coronary artery bypass grafting: Results from the PRoject of Ex-vivo Vein graft ENgineering via Transfection Ⅳ (PREVENT-Ⅳ) Trial. Am Heart J, 2009, 158(5): 792-798.
28. Gillinov AM, Bagiella E, Moskowitz AJ, et al. Rate control versus rhythm control for atrial fibrillation after cardiac surgery. N Engl J Med, 2016, 374(20): 1911-1921.
29. Dobrev D, Aguilar M, Heijman J, et al. Postoperative atrial fibrillation: mechanisms, manifestations and management. Nat Rev Cardiol, 2019, 16(7): 417-436.
30. Andrade JG, Verma A, Mitchell LB, et al. 2018 focused update of the Canadian Cardiovascular Society guidelines for the management of atrial fibrillation. Can J Cardiol, 2018, 34(11): 1371-1392.
31. Lin MH, Kamel H, Singer DE, et al. Perioperative/postoperative atrial fibrillation and risk of subsequent stroke and/or mortality. Stroke, 2019, 50(6): 1364-1371.
32. Megens MR, Churilov L, Thijs V. New-onset atrial fibrillation after coronary artery bypass graft and long-term risk of stroke: a meta-analysis. J Am Heart Assoc, 2017, 6(12): e007558.
33. Friberg L, Rosenqvist M, Lip GY. Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish atrial fibrillation cohort study. Eur Heart J, 2012, 33(12): 1500-1510.
34. Butt JH, Xian Y, Peterson ED, et al. Long-term thromboembolic risk in patients with postoperative atrial fibrillation after coronary artery bypass graft surgery and patients with nonvalvular atrial fibrillation. JAMA Cardiol, 2018, 3(5): 417-424.
35. Crystal A, Freitas C, Yu B, et al. New onset peri-operative atrial fibrillation after coronary artery bypass graft (CABG) surgery. Circulation, 2018, 138: A13249.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Perioperative management of new-onset atrial fibrillation after cardiac surgery

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