Top

BMC Cardiovascular Disorders

Published in:

Open Access 01-12-2021 | Heart Surgery | Research article

Biochemical predictors of postoperative atrial fibrillation following cardiac surgery

Authors: Sevket T. Turkkolu, Emre Selçuk, Cengiz Köksal

Published in: BMC Cardiovascular Disorders | Issue 1/2021

Abstract

Background

New-onset postoperative atrial fibrillation (POAF) is common after cardiac surgery. Early identification of its risk factors during the preoperative period would help in reducing the associated morbidity, mortality, and healthcare costs.

Aim of the study

This study aimed to identify the predictors of POAF following open cardiac surgery, with emphasis on biochemical parameters.

Methods

A total of 1191 patients with no preoperative atrial fibrillation (AF) and undergoing open cardiac surgery for any reason were included in this retrospective study. Data on clinical and biochemical parameters, the occurrence of new-onset AF, and its clinical course were retrieved from the hospital database.

Results

During the early postoperative period 330 patients (27.7%) developed atrial fibrillation, at median third postoperative day (range 1–6 days) and 217 (65.8%) responded to treatment. Multivariate analysis identified the following as the significant independent predictors of any POAF: EF < 60% (Odds ratio (OR), 2.6), valvular intervention (OR, 2.4), liver failure (OR, 2.4), diabetes (OR, 1.6), low hematocrit (OR, 2.1), low thrombocyte (OR, 5.6), low LDL (OR, 1.6), high direct bilirubin (OR, 2.0), low GFR (OR, 1.6), and high CRP (OR, 2.0). Following parameters emerged as significant independent predictors of persistent AF: EF < 60% (OR, 1.9), diabetes (OR, 2.1), COPD (OR, 1.8), previous cardiac surgery (OR, 3.1), valvular intervention (OR, 2.4), low hematocrit (OR, 1.9), low LDL (OR, 2.1), high HbA1c (OR, 2.0), and high CRP (OR, 2.7).

Conclusions

Certain parameters assessed during preoperative physical and laboratory examinations have the potential to be used as markers of POAF.

Axtell AL, Moonsamy P, Melnitchouk S, Tolis G, Jassar AS, D’Alessandro DA, et al. Preoperative predictors of new-onset prolonged atrial fibrillation after surgical aortic valve replacement. J Thorac Cardiovasc Surg. 2020;159(4):1407–14. https://doi.org/10.1016/j.jtcvs.2019.04.077.CrossRefPubMed

Weymann A, Popov AF, Sabashnikov A, Ali-Hasan-Al-Saegh S, Ryazanov M, Tse G, et al. Baseline and postoperative levels of C-reactive protein and interleukins as inflammatory predictors of atrial fibrillation following cardiac surgery: a systematic review and meta-analysis. Kardiol Pol. 2018;76(2):440–51. https://doi.org/10.5603/KP.a2017.0242.CrossRefPubMed

Tadic M, Ivanovic B, Zivkovic N. Predictors of atrial fibrillation following coronary artery bypass surgery. Med Sci Monit. 2011;17(1):48–55. https://doi.org/10.12659/msm.881329.CrossRef

Li T, Sun ZL, Xie QY. Meta-analysis identifies serum C-reactive protein as an indicator of atrial fibrillation risk after coronary artery bypass graft. Am J Ther. 2016;23(6):e1586–96. https://doi.org/10.1097/MJT.0000000000000255.CrossRefPubMed

Bessissow A, Khan J, Devereaux PJ, Alvarez-Garcia J, Alonso-Coello P. Postoperative atrial fibrillation in non-cardiac and cardiac surgery: an overview. J Thromb Haemost. 2015;13:304–12. https://doi.org/10.1111/jth.12974.CrossRef

Nair SG. Atrial fibrillation after cardiac surgery. Ann Card Anaesth. 2010;13(3):196–205. https://doi.org/10.4103/0971-9784.69047.CrossRefPubMed

Danelich IM, Lose JM, Wright SS, Asirvatham SJ, Ballinger BA, Larson D, et al. Practical management of postoperative atrial fibrillation after noncardiac surgery. J Am Coll Surg. 2014;219(4):831–41. https://doi.org/10.1016/j.jamcollsurg.2014.02.038.CrossRefPubMed

Dobrev D, Aguilar M, Heijman J, Guichard JB, Nattel S. Postoperative atrial fibrillation: mechanisms, manifestations and management. Nat Rev Cardiol. 2019;16(7):417–36. https://doi.org/10.1038/s41569-019-0166-5.CrossRefPubMed

Turagam MK, Mirza M, Werner PH, Sra J, Kress DC, Tajik AJ, et al. Circulating biomarkers predictive of postoperative atrial fibrillation. Cardiol Rev. 2016;24(2):76–87. https://doi.org/10.1097/CRD.0000000000000059.CrossRefPubMedPubMedCentral

10.

Guan B, Li X, Xue W, Tse G, Waleed KB, Liu Y, et al. Blood lipid profiles and risk of atrial fibrillation: a systematic review and meta-analysis of cohort studies. J Clin Lipidol. 2020;14(1):133–42. https://doi.org/10.1016/j.jacl.2019.12.002.CrossRefPubMed

11.

Li XY, Hou HT, Chen HX, Liu XC, Wang J, Yang Q, He GW. Preoperative plasma biomarkers associated with atrial fibrillation after coronary artery bypass surgery. J Thorac Cardiovasc Surg. 2020. https://doi.org/10.1016/j.jtcvs.2020.01.079.CrossRefPubMedPubMedCentral

12.

Gorczyca I, Michta K, Pietrzyk E, Wożakowska-Kapłon B. Predictors of post-operative atrial fibrillation in patients undergoing isolated coronary artery bypass grafting. Kardiol Pol. 2018;76(1):195–201. https://doi.org/10.5603/KP.a2017.0203.CrossRefPubMed

13.

Cerit L, Kemal H, Gulsen K, Ozcem B, Cerit Z, Duygu H. Relationship between Vitamin D and the development of atrial fibrillation after on-pump coronary artery bypass graft surgery. Cardiovasc J Afr. 2017;2:104–7. https://doi.org/10.5830/CVJA-2016-064.CrossRef

14.

Chua SK, Shyu KG, Lu MJ, Hung HF, Cheng JJ, Lee SH, et al. Association between renal function, diastolic dysfunction, and postoperative atrial fibrillation following cardiac surgery. Circ J. 2013;77(9):2303–10.CrossRef

15.

January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC, et al. (2014) ACC/AHA Task Force Members: 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014;130(23):e199-267. https://doi.org/10.1161/CIR.0000000000000041.CrossRefPubMedPubMedCentral

16.

Magne J, Salerno B, Mohty D, Serena C, Rolle F, Piccardo A, et al. Echocardiography is useful to predict postoperative atrial fibrillation in patients undergoing isolated coronary bypass surgery: a prospective study. Eur Heart J Acute Cardiovasc Care. 2019;8(2):104–13. https://doi.org/10.1177/2048872616688419.CrossRefPubMed

17.

Elawady MA, Bashandy M. Clinical and echocardiographic predicators of postoperative atrial fibrillation. Asian Cardiovasc Thorac Ann. 2014;22(6):655–9. https://doi.org/10.1177/0218492313503572.CrossRefPubMed

18.

Zangrillo A, Landoni G, Sparicio D, Benussi S, Aletti G, Pappalardo F, et al. Predictors of atrial fibrillation after off-pump coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth. 2004;18(6):704–8. https://doi.org/10.1053/j.jvca.2004.08.005.CrossRefPubMed

19.

Mariscalco G, Biancari F, Zanobini M, Cottini M, Piffaretti G, Saccocci M, et al. Bedside tool for predicting the risk of postoperative atrial fibrillation after cardiac surgery: the POAF score. J Am Heart Assoc. 2014;3(2):e000752. https://doi.org/10.1161/JAHA.113.000752.CrossRefPubMedPubMedCentral

20.

Conti VR, Ware DL. Cardiac arrhythmias in cardiothoracic surgery. Chest Surg Clin N Am. 2002;12(2):439–60. https://doi.org/10.1016/s1052-3359(02)00006-6.PMID.CrossRefPubMed

21.

Kinoshita T, Asai T, Takashima N, Hosoba S, Suzuki T, Kambara A, et al. Preoperative C-reactive protein and atrial fibrillation after off-pump coronary bypass surgery. Eur J Cardiothorac Surg. 2011;40(6):1298–303. https://doi.org/10.1016/j.ejcts.2011.03.027.CrossRefPubMed

22.

Bruins P, TeVelthuis H, Yazdanbakhsh AP, Jansen PG, vanHardevelt FW, deBeaumont EM, et al. Activation of the complement system during and after cardiopulmonary bypass surgery: postsurgery activation involves C-reactive protein and is associated with postoperative arrhythmia. Circulation. 1997;96(10):3542–8. https://doi.org/10.1161/01.cir.96.10.3542.CrossRefPubMed

23.

Şaşkın H, Düzyol Ç, Aksoy R, Özcan KS, Güngör B, İdiz M. Do preoperative C-reactive protein and mean platelet volume levels predict development of postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass grafting? Postepy Kardiol Interwencyjnej. 2016;12(2):156–63. https://doi.org/10.5114/aic.2016.59366.CrossRefPubMedPubMedCentral

24.

Weymann A, Ali-Hasan-Al-Saegh S, Sabashnikov A, Popov AF, Mirhosseini SJ, Liu T, et al. Prediction of new-onset and recurrent atrial fibrillation by complete blood count tests: a comprehensive systematic review with meta-analysis. Med Sci Monit Basic Res. 2017;12(23):179–222. https://doi.org/10.12659/msmbr.903320.CrossRef

25.

Weymann A, Ali-Hasan-Al-Saegh S, Popov AF, Sabashnikov A, Mirhosseini SJ, Liu T, et al. Haematological indices as predictors of atrial fibrillation following isolated coronary artery bypass grafting, valvular surgery, or combined procedures: a systematic review with meta-analysis. Kardiol Pol. 2018;76(1):107–18. https://doi.org/10.5603/KP.a2017.0179.CrossRefPubMed

26.

Kodani E, Inoue H, Atarashi H, Okumura K, Yamashita T, Origasa H, et al. Impact of hemoglobin concentration and platelet count on outcomes of patients with non-valvular atrial fibrillation: a subanalysis of the J-RHYTHM Registry. Int J Cardiol. 2020;1(302):81–7. https://doi.org/10.1016/j.ijcard.2019.11.127.CrossRef

27.

Alameddine AK, Visintainer P, Alimov VK, Rousou JA. Blood transfusion and the risk of atrial fibrillation after cardiac surgery. J Card Surg. 2014;29(5):593–9. https://doi.org/10.1111/jocs.12383.CrossRefPubMed

28.

Abbaszadeh S, Shafiee A, Bina P, Jalali A, Sadeghian S, Karimi A. Preoperative hemoglobin A1c and the occurrence of atrial fibrillation following on-pump coronary artery bypass surgery in type-2 diabetic patients. Crit Pathw Cardiol. 2017;16(1):37–41. https://doi.org/10.1097/HPC.0000000000000103.CrossRefPubMed

29.

Kinoshita T, Asai T, Suzuki T, Kambara A, Matsubayashi K. Preoperative hemoglobin A1c predicts atrial fibrillation after off-pump coronary bypass surgery. Eur J Cardiothorac Surg. 2012;41(1):102–7. https://doi.org/10.1016/j.ejcts.2011.04.011.CrossRefPubMed

30.

Zhao H, Liu M, Chen Z, Mei K, Yu P, Xie L. Dose-response analysis between hemoglobin A1c and risk of atrial fibrillation in patients with and without known diabetes. PLoS ONE. 2020;15(2):e0227262. https://doi.org/10.1371/journal.pone.0227262.CrossRefPubMedPubMedCentral

31.

Mora S, Akinkuolie AO, Sandhu RK, Conen D, Albert CM. Paradoxical association of lipoprotein measures with incident atrial fibrillation. Circ Arrhythm Electrophysiol. 2014;7(4):612–9. https://doi.org/10.1161/CIRCEP.113.001378.CrossRefPubMedPubMedCentral

32.

Lopez FL, Agarwal SK, Maclehose RF, Soliman EZ, Sharrett AR, Huxley R, et al. Blood lipid levels, lipid-lowering medications, and the incidence of atrial fibrillation: the atherosclerosis risk in communities study. Circ Arrhythm Electrophysiol. 2012;5(1):155–62. https://doi.org/10.1161/CIRCEP.111.966804.CrossRefPubMedPubMedCentral

33.

Yao Y, Liu F, Wang Y, Liu Z. Lipid levels and risk of new-onset atrial fibrillation: a systematic review and dose-response meta-analysis. Clin Cardiol. 2020;43(9):935–43. https://doi.org/10.1002/clc.23430.CrossRefPubMedPubMedCentral

34.

Li ZZ, Du X, Guo XY, Tang RB, Jiang C, Liu NC, et al. Association between blood lipid profiles and atrial fibrillation: a case-control study. Med Sci Monit. 2018;24:3903–8.CrossRef

35.

Aydin M, Susam I, Kilicaslan B, Dereli M, Sacar M, Ozdogan O. Serum cholesterol levels and postoperative atrial fibrillation. J Cardiothorac Surg. 2014;9(1):1–4. https://doi.org/10.1186/1749-8090-9-69.CrossRef

36.

Patti G, Bennett R, Seshasai SR, Cannon CP, Cavallari I, Chello M, et al. Statin pretreatment and risk of in-hospital atrial fibrillation among patients undergoing cardiac surgery: a collaborative meta-analysis of 11 randomized controlled trials. Europace. 2015;17(6):855–63. https://doi.org/10.1093/europace/euv001.CrossRefPubMed

37.

Yin L, Wang Z, Wang Y, Ji G, Xu Z. Effect of statins in preventing postoperative atrial fibrillation following cardiac surgery. Heart Lung Circ. 2010;19(10):579–83. https://doi.org/10.1016/j.hlc.2010.06.664.CrossRefPubMed

38.

Demir M, Demir C, Uyan U, Melek M. The relationship between serum bilirubin concentration and atrial fibrillation. Cardiol Res. 2013;4(6):186–91. https://doi.org/10.4021/cr299w.CrossRefPubMed

39.

Sun D, Li W, Zheng W, Tan J, Zhang G. Direct bilirubin level is an independent risk factor for atrial fibrillation in thyrotoxic patients receiving radioactive iodine therapy. Nucl Med Commun. 2019;40(12):1289–94. https://doi.org/10.1097/MNM.0000000000001107.CrossRefPubMed

40.

Lin SP, Lin PY, Jiang HL, Long YM, Chen XH. Is serum total bilirubin useful to differentiate cardioembolic stroke from other stroke subtypes? Neurol Res. 2015;8:727–31. https://doi.org/10.1179/1743132815Y.0000000038.CrossRef

41.

Chen SC, Chung FP, Chao TF, Hu YF, Lin YJ, et al. A link between bilirubin levels and atrial fibrillation recurrence after catheter ablation. J Chin Med Assoc. 2019;82(3):175–8. https://doi.org/10.1097/JCMA.0000000000000026.CrossRefPubMed

Title: Biochemical predictors of postoperative atrial fibrillation following cardiac surgery
Authors: Sevket T. Turkkolu
Emre Selçuk
Cengiz Köksal
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Heart Surgery
Heart Surgery
Atrial Fibrillation
Chronic Obstructive Lung Disease
Published in: BMC Cardiovascular Disorders / Issue 1/2021
Electronic ISSN: 1471-2261
DOI: https://doi.org/10.1186/s12872-021-01981-z

ACC 2024 Congress Coverage

Heart Failure Video

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Biochemical predictors of postoperative atrial fibrillation following cardiac surgery

Abstract

Background

Aim of the study

Methods

Results

Conclusions

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Aim of the study

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Clinical outcomes of nicorandil administration in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a systematic review and meta-analysis of randomized controlled trials

The role of brain natriuretic peptide in atrial fibrillation: a substudy of the Substrate Modification with Aggressive Blood Pressure Control for Atrial Fibrillation (SMAC-AF) trial

The death risk factors of patients undergoing re-exploration for bleeding or tamponade after isolated off-pump coronary artery bypass grafting: a case–control study

Clinical prediction scores and early anticoagulation therapy for new-onset atrial fibrillation in critical illness: a post-hoc analysis

Aerobic exercise, but not isometric handgrip exercise, improves endothelial function and arterial stiffness in patients with myocardial infarction undergoing coronary intervention: a randomized pilot study

Exploring the diagnostic effectiveness for myocardial ischaemia based on CCTA myocardial texture features

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page