Preoperative echocardiographic predictors of atrial fibrillation after coronary artery bypass graft surgery (CABG): a systematic review and meta-analysis

Background Postoperative atrial fibrillation (POAF) is a common complication after coronary artery bypass grafting (CABG), which is associated with increased morbidity, longer hospital stays, and higher healthcare costs. Preoperative echocardiographic parameters may play an important role in predicting the risk of POAF. Objective To identify and evaluate preoperative echocardiographic parameters that can predict the development of POAF in patients undergoing CABG. Methods A systematic search was performed from January 2010 to October 2025 in PubMed, Scopus, Embase, and Web of Science. Risk of bias was assessed with ROBINS-I tool for observational studies. Results Twenty-three studies (n = 2,983 patients) were included. POAF incidence ranged from 22% to 40%, with a pooled rate of 28.8% (95% CI: 21%–34%). Meta-analyses showed no significant pooled associations for left atrial volume index (LAVI) (OR 1.31; 95% CI: 0.92–1.87; I² = 99.9%), peak atrial longitudinal strain (PALS) 0.65 (95% CI: 0.38–1.11); I² = 99.9%), or LA contraction strain (LASRa) (OR 1.91; 95% CI: 0.83–4.41; I² = 98.1%). Heterogeneity was substantial across all outcomes. Limited data suggested potential predictive value for right atrial indices and single-study parameters such as LA kinetic energy. Conclusion Current echocardiographic markers including LAVI, PALS, and LASRa, do not demonstrate consistent or robust predictive value for POAF when pooled across heterogeneous studies. Standardized measurement protocols and larger prospective cohorts are needed to clarify the role of atrial structural and functional indices in POAF risk stratification.