Features of intraoperative management during heart surgery affecting the development of postoperative atrial fibrillation

   Objective: to determine whether the features of the performed cardiac surgery influence the development of atrial fibrillation in the early postoperative period.

   Materials and methods: the study included patients operated on in the Cardiac Surgery Department No. 2 of the Research Institute — Regional Clinical Hospital No. 1 of Krasnodar in the period from July 1, 2022 to January 1, 2023. During the analyzed period of time, open heart surgery was performed in 552 patients, 60 of whom had postoperative atrial fibrillation (this cohort was called the main group A). Sinus rhythm was recorded in 424 patients, and therefore, using a random number generator, a comparison group (group B) identical in number to the main group was formed, which consisted of 64 patients.

   Results: in total, 60 patients (10.9%) developed atrial fibrillation in the
early postoperative period, on average on the 3rd postoperative day (range 1–6 days). Evaluation of the performed surgical intervention showed that patients with postoperative atrial fibrillation more often underwent heart valve replacement surgery or combined prosthetic valve surgery with bypass grafting. If isolated coronary surgery was performed, patients were more likely to tolerate cardiopulmonary bypass, had a longer aortic clamping time, and underwent multivessel bypass with two or more anastomoses.

   Conclusion: it is extremely important to find predictors of postoperative atrial fibrillation and, by successfully acting on them, to minimize the likelihood of developing a stroke as a complication of atrial fibrillation, without prolonging the length of stay in the hospital and preventing the burden of such severe consequences of a stroke on the patient’s body and on the healthcare system as a whole, such as severe neurological deficit and disability.

1. Dzhioeva O.N., Drapkina O.M. Postoperative atrial fibrillation as a risk factor for cardiovascular complications in non-cardiac surgery. Cardiovascular Therapy and Prevention. 2020;19(4):2540. (In Russ.) DOI: 10.15829/1728-8800-2020-2540

2. Greenberg JW, Lancaster TS, Schuessler RB, Melby SJ. Postoperative atrial fibrillation following cardiac surgery: a persistent complication. Eur J Cardiothorac Surg. 2017;52(4):665-672. DOI: 10.1093/ejcts/ezx039

3. Lomivorotov V.V., Efremov S.M., Pokushalov E.A., Boboshko V.A. Atrial fibrillation after cardiac surgery: pathophysiologyand prevention techniques. Messenger of anesthesiology and resuscitation. 2017;14(1):58-66. (In Russ.) DOI: 10.21292/2078-5658-2017-14-1-58-66

4. Dobrev D, Aguilar M, Heijman J, Guichard JB, Nattel S. Postoperative atrial fibrillation: mechanisms, manifestations and management. Nat Rev Cardiol. 2019;16(7):417-436. DOI: 10.1038/s41569-019-0166-5

5. Kanametov T.N., Paskhalov I.D., Bockeria L.A. Postoperative atrial fibrillation during extracardiac and cardiac surgical interventions. Annals of Arrhythmology. 2022;19(1):4-13. (In Russ.) eLIBRARY ID: 49493061 EDN: XQOQSV

6. Lebedev D.I., Evtushenko A.V., Khorlampenko A.A. Factors for the development of atrial fibrillation after open heart surgery. Complex Issues of Cardiovascular Diseases. 2021;10(2):40-44. (In Russ.) DOI: 10.17802/2306-1278-2021-10-2S-40-44

7. Zakkar M, Ascione R, James AF, Angelini GD, Suleiman MS. Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery. Pharmacol Ther. 2015;154:13-20. DOI: 10.1016/j.pharmthera.2015.06.009

8. Sokolskaya M.A., Shvartz V.A., Ispiryan A.Yu., Petrosyan A.D., Paskhalov I.D., Abgaryan A.A., et al. Predictors of the development of postoperative atrial fibrillation after aortic valve replacement in patients with aortic insufficiency. Annals of arrhythmology. 2020;17(4):220-231. (In Russ.) DOI: 10.15275/annaritmol.2020.4.1

9. Gaudino M, Di Franco A, Rong LQ, Piccini J, Mack M. Postoperative atrial fibrillation: from mechanisms to treatment. Eur Heart J. 2023;44(12):1020-1039. DOI: 10.1093/eurheartj/ehad019

10. Malhotra P, Pande S, Mahindru S, Thukral A, Kotwal AS, Gupta RP, et al. Postoperative atrial fibrillation in coronary artery bypass grafting herald poor outcome. Ann Card Anaesth. 2021;24(4):464-469. DOI: 10.4103/aca.ACA_30_20

11. Baikoussis NG, Papakonstantinou NA, Verra C, Kakouris G, Chounti M, Hountis P, et al. Mechanisms of oxidative stress and myocardial protection during open-heart surgery. Ann Card Anaesth. 2015;18(4):555-564. DOI: 10.4103/0971-9784.166465

12. Engin M, Aydın U, Cebeci G, Ata Y. New-onset postoperative atrial fibrillation after coronary artery bypass graft surgery. Kardiol Pol. 2022;80(10):1060-1061. DOI: 10.33963/KP.a2022.0149

13. Bessissow A, Khan J, Devereaux PJ, Alvarez-Garcia J, Alonso-Coello P. Postoperative atrial fibrillation in non-cardiac and cardiac surgery : an overview. J Thromb Haemost. 2015;13 Suppl 1:S304-12. Erratum in: J Thromb Haemost. 2015;13(11):2134. DOI: 10.1111/jth.12974.

14. Shen J, Lall S, Zheng V, Buckley P, Damiano RJ Jr, Schuessler RB. The persistent problem of new-onset postoperative atrial fibrillation: a single-institution experience over two decades. J Thorac Cardiovasc Surg. 2011;141(2):559-570. DOI: 10.1016/j.jtcvs.2010.03.011

15. Anogeianaki A, Angelucci D, Cianchetti E, D’Alessandro M, Maccauro G, Saggini A, et al. Atherosclerosis: a classic inflammatory disease. Int J Immunopathol Pharmacol. 2011;24(4):817-825. DOI: 10.1177/039463201102400401

16. Lin MH, Kamel H, Singer DE, Wu YL, Lee M, Ovbiagele B. Perioperative/Postoperative Atrial Fibrillation and Risk of Subsequent Stroke and/or Mortality. Stroke. 2019;50(6):1364-1371. DOI: 10.1161/STROKEAHA.118.023921