Risk and protective factors for atrial fibrillation after cardiac surgery and valvular interventions: an umbrella review of meta-analyses
Costas Tsioufis,
Farkas Vánky,
Elena Dragioti,
Joakim Alfredsson,
Emmanouil Charitakis,
Lars O Karlsson,
Dimitrios Tsartsalis,
Håkan Walfridsson,
Constantina Aggeli,
Efstratios I Charitos,
Dafni Korela,
Maria Stratinaki,
Emmanouil Foukarakis
Affiliations
Costas Tsioufis
7 Department of Cardiology, Ippokrateion University Hospital, Athens, Greece
Farkas Vánky
Cardiothoracic and Vascular Surgery, Linköping University, Linkoping, Sweden
Elena Dragioti
13 Pain and Rehabilitation Centre and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
Joakim Alfredsson
Department of Cardiology and Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences, Linköping University Linköping, Linkopings Universitet, Linkoping, Sweden
Emmanouil Charitakis
1 Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University Hospital, Linköping, Sweden
Lars O Karlsson
1 Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University Hospital, Linköping, Sweden
Dimitrios Tsartsalis
5 Department of Clinical Physiology, Linköping University Hospital, Linköping, Sweden
Håkan Walfridsson
1Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
Constantina Aggeli
1First Department of Cardiology, Hippokration Hospital, Athens, Greece
Efstratios I Charitos
2Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany
Dafni Korela
Department of Cardiology, Venizeleio General Hospital, Heraklion, Greece
Maria Stratinaki
Department of Cardiology, Venizeleio General Hospital, Heraklion, Greece
Emmanouil Foukarakis
Department of Cardiology, Venizeleio General Hospital, Heraklion, Greece
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.
