You are here

  • Home
  • Archive
  • Volume 9, Issue 2
  • Risk and protective factors for atrial fibrillation after cardiac surgery and valvular interventions: an umbrella review of meta-analyses

Article Text

Article menu
Arrhythmias and sudden death
Original research
Risk and protective factors for atrial fibrillation after cardiac surgery and valvular interventions: an umbrella review of meta-analyses
  1. Emmanouil Charitakis1,
  2. Dimitrios Tsartsalis2,3,
  3. Dafni Korela4,
  4. Maria Stratinaki4,
  5. Farkas Vanky1,
  6. Efstratios I Charitos5,
  7. Joakim Alfredsson1,
  8. Lars O Karlsson1,
  9. Emmanouil Foukarakis4,
  10. Constantina Aggeli3,
  11. Costas Tsioufis3,
  12. Håkan Walfridsson1 and
  13. Elena Dragioti6
  1. 1Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
  2. 2Department of Emergency Medicine, Hippokration Hospital, Athens, Greece
  3. 3First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
  4. 4Department of Cardiology, Venizeleio General Hospital, Heraklion, Greece
  5. 5Department of Cardiac Surgery, Kerckhoff Hospital, Bad Nauheim, Hessen, Germany
  6. 6Pain and Rehabilitation Centre and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
  1. Correspondence to Dr Emmanouil Charitakis; emmanouil.charitakis{at}liu.se

Abstract

Objective Postoperative atrial fibrillation (POAF) is a common complication affecting approximately one-third of patients after cardiac surgery and valvular interventions. This umbrella review systematically appraises the epidemiological credibility of published meta-analyses of both observational and randomised controlled trials (RCT) to assess the risk and protective factors of POAF.

Methods Three databases were searched up to June 2021. According to established criteria, evidence of association was rated as convincing, highly suggestive, suggestive, weak or not significant concerning observational studies and as high, moderate, low or very low regarding RCTs.

Results We identified 47 studies (reporting 61 associations), 13 referring to observational studies and 34 to RCTs. Only the transfemoral transcatheter aortic valve replacement (TAVR) approach was associated with the prevention of POAF and was supported by convincing evidence from meta-analyses of observational data. Two other associations provided highly suggestive evidence, including preoperative hypertension and neutrophil/lymphocyte ratio. Three associations between protective factors and POAF presented a high level of evidence in meta-analyses, including RCTs. These associations included atrial and biatrial pacing and performing a posterior pericardiotomy. Nineteen associations were supported by moderate evidence, including use of drugs such as amiodarone, b-blockers, glucocorticoids and statins and the performance of TAVR compared with surgical aortic valve replacement.

Conclusions Our study provides evidence confirming the protective role of amiodarone, b-blockers, atrial pacing and posterior pericardiotomy against POAF as well as highlights the risk of untreated hypertension. Further research is needed to assess the potential role of statins, glucocorticoids and colchicine in the prevention of POAF.

PROSPERO registration number CRD42021268268.

  • Meta-Analysis
  • Atrial Fibrillation
  • Cardiac Surgical Procedures
  • Transcatheter Aortic Valve Replacement
  • Risk Factors

Data availability statement

Data are available upon reasonable request. The datasets used and/or analyzed during the current study are available from the corresponding author.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/openhrt-2022-002074

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    Data are available upon reasonable request. The datasets used and/or analyzed during the current study are available from the corresponding author.

    View Full Text

    Supplementary materials

    • Supplementary Data

      This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Footnotes

    • Contributors EC, DT and ED designed the study. MS and DK performed a comprehensive screening of the literature, selected the studies included in the meta-analysis and abstracted the data items. ED and DT performed the statistical analysis. EC drafted the manuscript and is the guarantor of the paper. EC, ED, DT, MS, DK, LOK, FV, EIC, JA, EF, CA, CT, and HW interpreted the results and edited the manuscript critically. All the co-authors have read and accepted this version of the manuscript.

    • Funding Emmanouil Charitakis has received funding from ALF grants (County Council of Östergötland) RÖ818141.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.