Incidence of stroke in patients with atrial fibrillation undergoing surgical treatment: a meta-analysis

INTRODUCTION: Atrial fibrillation (AF) is self-limiting condition, but it may also increase the risk of stroke and death. The association between AF and surgery with stroke was assessed both subjectively and statistically using systematic review and meta-analysis. METHODS: For data collection, a thorough search was made in PubMed, EMBASE, Science Direct, Google Scholar, and Cochrane Library using searching keywords "postoperative ischemic stroke, atrial fibrillation, stroke, cardiac surgery, brain ischemia, and heart surgery". Direct and indirect comparisons were made using random-effect network meta-analysis. RESULTS: 16-studies were identified comprising of 132,208 patient, 64% male, median age > 63 years and follow-up > 1.5 years. Pooling the results from the random-effects model showed odds ratios associated with the risk of stroke of surgical processes (CABG) in patients with AF. The odds ratio OR = 1.1 (0.65-1.54, P < 0.001) and heterogeneity (I2 = 17%, P = 0.13) exposing higher risk of the stroke. Odds ratio (HR 1.5, 0.9-1.71) without heterogeneity showed greater risk of stroke after heart valve surgery in patients with AF. Study 8 didn't show any risk of the stroke after left atrial appendage (LAA) clipping intervention, but the outcomes were biased. A pooled analysis showed odd ratio OR, 2 (1.7-2.1, P < 0.0001), without heterogeneity indicating higher stroke risk in general cardiac surgery. The patients undergone cardiac surgery from three studies with pooled analysis study-5 OR 2 (1.7-2.1, P > 0.001), study-6 OR 1.8 (1.7-1.9, P > 0.001), and study-14 OR 7.8 (6.2-8.1, P > 0.0001). CONCLUSION: The study clearly defines stroke outcomes when they are quantified, however, further research is required.