What is the clinical evidence from this study?

Study design: Cohort. Population: Post-operative atrial fibrillation (POAF) (n=249). Intervention: Higher Body Mass Index (BMI) vs. Lower Body Mass Index (BMI). Primary outcome: Incident post-operative atrial fibrillation (POAF) (OR 1.11, 95% CI 1.03-1.2, p=0.006).

October 15, 2020Journal of Cardiothoracic Surgery13 citationsOpen Access

Overweight and aging increase the risk of atrial fibrillation after cardiac surgery independently of left atrial size and left ventricular ejection fraction

PSPierluigi Stefàno MBMarco Bugetti GMGuido Del Monaco

Key Result

Advanced age (OR 1.05) and higher BMI (OR 1.11) independently increased the risk of post-operative atrial fibrillation after cardiac surgery, regardless of left atrial size and ejection fraction.

Study Design

Type

Cohort (n=249)

Multicenter

Structured PICO

Do age, BMI, left atrial dimension, and LVEF predict the risk of post-operative atrial fibrillation in patients undergoing cardiac surgery without prior atrial dysrhythmia?

Population

249 adult patients (mean age 65.6 years, 37.3% female) without prior atrial dysrhythmia undergoing cardiac or aortic surgery, monitored for incident post-operative atrial fibrillation over the first 7 days postoperatively.

Outcome

Occurrence of post-operative atrial fibrillation (POAF) during the early postoperative period (time between surgery and discharge, defined as any sustained > 10 min recorded episodes)hard clinical

Advanced age and higher BMI are strong, independent risk factors for post-operative atrial fibrillation in patients undergoing cardiac surgery, regardless of left atrial size and left ventricular ejection fraction.

Main Result

Odds Ratio: 1.11 (95% CI 1.03–1.2)

p-value: p=0.006

Limitations

Retrospective cohort design
Single-center study

Abstract

Abstract Background Body mass index (BMI), age, left atrium (LA) dimension and left ventricular ejection fraction (LVEF) have been linked to post-operative atrial fibrillation (POAF) after cardiac surgery. The aim of this study was to better define the role of these risk factors. Methods This retrospective cohort study evaluated 249 patients (without prior atrial dysrhythmia) undergoing cardiac or aortic surgery. Prior to surgery, the following data were collected: age, BMI, LA diameter, LA area, LVEF, thyroid stimulating hormone (TSH), creatinine and the presence of arterial hypertension (AH) and diabetes. Intraoperative data such as operation time, total clamp time, cardiopulmonary bypass time, and presence of pericardial/pleural effusion were also collected. Only patients without pre- and post-surgery prophylactic anti-arrhythmic therapy were included. Results Patients with ( N = 127, 51%) and without POAF ( N = 122, 49%) were compared. No difference was observed for sex, LA diameter, LA area, LVEF, TSH, diabetes and use of ACE inhibitors or statins prior to intervention. Moreover, no difference was observed in terms of operation time, total clamp time, cardiopulmonary bypass time, and presence of pericardial/pleural effusion. However, patients with POAF were older (70.6 ± 10.7 vs. 60.4 ± 16.4 years, p = 0.001), had higher BMI (26.8 ± 4.5 vs. 24.9 ± 3.6 kg/m 2 , p = 0.001), higher baseline creatinine (1.06 ± 0.91 vs. 0.88 ± 0.32 mg/dL, p = 0.038) and a higher frequency of arterial hypertension (73.2% vs. 50%, p = 0.001) and Bentall procedure (24.4% vs. 9.8%, p = 0.023). Multivariate analysis showed that the only independent predictors of POAF were age (OR = 1.05, 95%CI 1.02–1.07, p = 0.001) and BMI (OR = 1.11 95%CI 1.03–1.2, p = 0.006). Conclusions These findings suggest that advanced age and a higher BMI are strong risk factors for POAF in patients without previous AF even in the presence of comparable LA dimensions and LVEF.

Ask AI

Helpful

Bookmark

View Full Paper