Korean Circ J.  2009 Mar;39(3):100-104. 10.4070/kcj.2009.39.3.100.

The Incidence and Predictors of Postoperative Atrial Fibrillation After Noncardiothoracic Surgery

• Sohn GH
• Shin DH
• Byun KM
• Han HJ
• Cho SJ
• Song YB
• Kim JH
• On YK
• Kim JS

• KMID: 1825966
• DOI: http://doi.org/10.4070/kcj.2009.39.3.100

Abstract

BACKGROUND AND OBJECTIVES: The incidence of postoperative atrial fibrillation after noncardiothoracic surgery is known to be very rare; there have been few prior studies on this topic. We evaluated the incidence, predictors, and prognosis of atrial fibrillation after noncardiothoracic surgery.
SUBJECTS AND METHODS
Patients who underwent noncardiothoracic surgery at our medical center under general anesthesia were enrolled. We reviewed medical records retrospectively and evaluated whether the atrial fibrillation developed postoperatively or was pre-existing. Patients who had a previous history of atrial fibrillation or atrial fibrillation on the pre-operative electrocardiogram were excluded.
RESULTS
Between January 2005 and December 2006, 7,756 patients (mean age: 69 years, male: 46%) underwent noncardiothoracic surgery in Samsung Medical Center and 30 patients (0.39%) were diagnosed with newly-developed atrial fibrillation. Patients who developed atrial fibrillation were significantly older and had significantly lower body mass indexes. Newly-developed atrial fibrillation was detected in 0.53% of the male patients and 0.26% of the female patients. The incidence of postoperative atrial fibrillation after an emergency operation was more frequent than that of elective operations (p<0.001). According to the multivariate analysis, age and emergency operations were independent predictors for new onset atrial fibrillation after noncardiothoracic surgery. Postoperative atrial fibrillation developed after a median of 2 days after the noncardiothoracic surgery and was associated with a longer hospitalization and increased in-hospital mortality. Four (13.3%) patients died and the causes of death were non-cardiovascular events such as pneumonia or hemorrhage.
CONCLUSION
Postoperative atrial fibrillation after noncardiothoracic surgery is a rare complication and is associated with older age and emergency operations. Patients who develop atrial fibrillation have longer hospitalizations and higher in-hospital mortality rates.

Keyword

Atrial fibrillation; Surgery; Postoperative complications

MeSH Terms

Anesthesia, General
Atrial Fibrillation
Body Mass Index
Cause of Death
Electrocardiography
Emergencies
Female
Hemorrhage
Hospital Mortality
Hospitalization
Humans
Incidence
Male
Medical Records
Multivariate Analysis
Pneumonia
Postoperative Complications
Prognosis
Retrospective Studies

Figure

• 

  Fig. 1 The postoperative day on which newly-developed atrial fibrillationz was observed. Postoperative atrial fibrillations after noncardiothoracic surgery developed after a median of 2 days (the earliest development was on the operation day and the latest onset was after 12 days).

Reference

1. Jeong JH. Prevalence of and risk factors for atrial fibrillation in Korean adults older than 40 years. J Korean Med Sci. 2005. 20:26–30.

2. Maisel WH, Rawn JD, Stevenson WG. Atrial fibrillation after cardiac surgery. Ann Intern Med. 2001. 135:1061–1073.

3. Christians KK, Wu B, Quebbeman EJ, Brasel KJ. Postoperative atrial fibrillation in noncardiothoracic surgical patients. Am J Surg. 2001. 182:713–715.

4. Krahn AD, Manfreda J, Tate RB, Mathewson FA, Cuddy TE. The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-Up Study. Am J Med. 1995. 98:476–484.

5. Falk RH. Atrial fibrillation. N Engl J Med. 2001. 344:1067–1078.

6. Brathwaite D, Weissman C. The new onset of atrial arrhythmias following major noncardiothoracic surgery is associated with increased mortality. Chest. 1998. 114:462–468.

7. Echahidi N, Pibarot P, O'Hara G, Mathieu P. Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery. J Am Coll Cardiol. 2008. 51:793–801.

8. Jongnarangsin K, Oral H. Postoperative atrial fibrillation. Med Clin North Am. 2008. 92:87–99.

9. Zacharias A, Schwann TA, Riordan CJ, Durham SJ, Shah AS, Habib RH. Obesity and risk of new-onset atrial fibrillation after cardiac surgery. Circulation. 2005. 112:3247–3255.

10. Curtis JP, Selter JG, Wang Y, et al. The obesity paradox: body mass index and outcomes in patients with heart failure. Arch Intern Med. 2005. 165:55–61.

11. Park SW. Multicenter trial for estimation of normal values of echocardiographic indices in Korea. Korean Circ J. 2000. 30:373–382.