Background
Atrial fibrillation (AF) is a common arrhythmia in the general
population and is more common in specific conditions such as cardiac and
non-cardiac surgery [1,2]. AF following surgery could occur in
patients who were or were not previously diagnosed with AF.
Post-operative atrial fibrillation (POAF) is defined as the development
of AF in the postoperative period in a patient who was not previously
diagnosed with AF [2,3].
Focusing on POAF following cardiac surgeries is important since it is
considered a common complication affecting patients following abundant
surgical procedures including coronary artery bypass grafting (CABG),
valve surgery, combined CABG and valve surgery, congenital defects
surgery, and even percutaneous coronary revascularization but with a
much lower risk than major surgical intervention [3-6]. The
occurrence of POAF increases in correlation with increasing invasiveness
of cardiac surgery, and may reach up to 60%, usually appearing within
the first 6 days after surgery with a peak in the
2nd-4th days [4-6].
POAF is associated with major morbidities such as prolonged mechanical
ventilation support, postoperative stroke, myocardial infarction,
cardiac arrest, permanent pacemaker, respiratory failure, pneumonia,
gastrointestinal complications, acute kidney injury, and a new onset of
dialysis. Furthermore, POAF leads to a longer hospital and intensive
care unit stay, higher treatment costs, hospital readmission, and most
importantly, 2 folds of increased mortality [6-8].
Risk factors that were reported to correlate with increased incidence of
POAF, were derived from epidemiological studies, and can be divided into
3 main groups: preoperative, intraoperative and postoperative factors
[9,10] . In the last 20 years, research has expanded in the field of
POAF and several modifications have been implemented to perioperative
management and surgical techniques, in an attempt to decrease POAF
incidence or its subsequent complications. However, more progress needs
to be made [11] . The aim of this study is to evaluate preoperative,
intra-operative risk factors and predictors of occurrence of overall AF
following cardiac surgery including patients previously diagnosed and
who were not previously diagnosed with AF (POAF).