AI Article Synopsis

  • Postoperative atrial fibrillation (POAF) is a frequent complication post-cardiac surgery, affecting about one-third of patients, and the study evaluates various risk and protective factors associated with it through existing meta-analyses.
  • The review analyzed data from 47 studies, confirming that the transfemoral transcatheter aortic valve replacement (TAVR) significantly helps prevent POAF, while notable protective factors include amiodarone, b-blockers, and certain surgical techniques.
  • The findings suggest a need for further research on the effects of statins, glucocorticoids, and colchicine in preventing POAF, alongside emphasizing the importance of managing preoperative hypertension.

Article Abstract

Objective: Postoperative atrial fibrillation (POAF) is a common complication affecting approximately one-third of patients after cardiac surgery and valvular interventions. This umbrella review systematically appraises the epidemiological credibility of published meta-analyses of both observational and randomised controlled trials (RCT) to assess the risk and protective factors of POAF.

Methods: Three databases were searched up to June 2021. According to established criteria, evidence of association was rated as convincing, highly suggestive, suggestive, weak or not significant concerning observational studies and as high, moderate, low or very low regarding RCTs.

Results: We identified 47 studies (reporting 61 associations), 13 referring to observational studies and 34 to RCTs. Only the transfemoral transcatheter aortic valve replacement (TAVR) approach was associated with the prevention of POAF and was supported by convincing evidence from meta-analyses of observational data. Two other associations provided highly suggestive evidence, including preoperative hypertension and neutrophil/lymphocyte ratio. Three associations between protective factors and POAF presented a high level of evidence in meta-analyses, including RCTs. These associations included atrial and biatrial pacing and performing a posterior pericardiotomy. Nineteen associations were supported by moderate evidence, including use of drugs such as amiodarone, b-blockers, glucocorticoids and statins and the performance of TAVR compared with surgical aortic valve replacement.

Conclusions: Our study provides evidence confirming the protective role of amiodarone, b-blockers, atrial pacing and posterior pericardiotomy against POAF as well as highlights the risk of untreated hypertension. Further research is needed to assess the potential role of statins, glucocorticoids and colchicine in the prevention of POAF.

Prospero Registration Number: CRD42021268268.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9454044PMC
http://dx.doi.org/10.1136/openhrt-2022-002074DOI Listing

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