TY - JOUR T1 - Risk and protective factors for atrial fibrillation after cardiac surgery and valvular interventions: an umbrella review of meta-analyses JF - Open Heart JO - Open Heart DO - 10.1136/openhrt-2022-002074 VL - 9 IS - 2 SP - e002074 AU - Emmanouil Charitakis AU - Dimitrios Tsartsalis AU - Dafni Korela AU - Maria Stratinaki AU - Farkas Vanky AU - Efstratios I Charitos AU - Joakim Alfredsson AU - Lars O Karlsson AU - Emmanouil Foukarakis AU - Constantina Aggeli AU - Costas Tsioufis AU - HÃ¥kan Walfridsson AU - Elena Dragioti Y1 - 2022/09/01 UR - http://openheart.bmj.com/content/9/2/e002074.abstract N2 - 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.Data are available upon reasonable request. The datasets used and/or analyzed during the current study are available from the corresponding author. ER -