Importance of Postoperative Atrial Fibrillation Development in Heart Surgery

Intra-Hospital Outcomes in Santa Catarina Tertiary Cardiology Center

  • Ricardo Pereira da Silva
  • Larissa Freitas Nunes Goldoni
  • Kárila Scarduelli Luciano
  • Ana Carolina Gern Junqueira
  • Ana Carolina Caldara Barreto
  • Rafael De March Ronsoni
Keywords: Atrial fibrillation, Postoperative care, Morbidity


Objective: To determine the incidence of postoperative atrial fibrillation (PAF) of cardiac surgery, its impact on morbimortality and duration of hospital stay in a tertiary cardiology center of the state of Santa Catarina, Brazil. Methods: Cohort study with 134 adult patients submitted to cardiac surgery. Results: the incidence was 32.8%. After multivariate analysis, patients who did not receive beta-blockers were associated with PAF with a relative risk odds ratio (RR) 10.73 (p <0.001). The highest rate of cardiovascular events (cerebrovascular accident, mortality, and acute coronary syndrome) was 25% in the PAF group. 10% (RR 3.21; p = 0.035) which, consequently, generated longer hospitalization time in these patients (19.1 vs. 12.5; p = 0.01). Conclusion: the incidence of PAF was high, caused a significant increase in morbimortality and duration of hospital stay, and consolidated the role of beta-blocker therapy in its prevention, and may serve as a basis for future prevention policies.


Shen J, Lall S, Zheng V, Buckley P, Damiano RJ, Schuessler RB. The persistent problem of new onset postoperative atrial fibrillation: a single institution experience over two

decades. The J Thorac Cardiovasc Surgery. 2011;141(2):559-70.

Villareal RP, Hariharam R, Liu BC, Kar B, Lee VV, Elayda M, et al. Postoperative atrial fibrillation and mortality after coronary artery bypass surgery. J Am Coll Cardiol. 2004;43(5):742-8.

Ommen SR, Odell JA, Marshall S. Stanton. Atrial arrhythmias after cardiothoracic surgery. N Engl J Med. 1997;336(20):1429-34.

Mariscalco G, Klersy C, Zanobini M, Banach M, Ferrarese S, Borsani P, et al. Atrial fibrillation after isolates coronary surgery affects late survival.Circulation. 2018;118(16):1612- 8. 10.1161/CIRCULATIONAHA.108.777789

Geovanini GR, Alves RJ, Brito G de, Miguel GAS, Glauser VA, Nakiri K. Fibrilação atrial no pós-operatório de cirurgia cardíaca: quem deve receber quimioprofilaxia? Arq Bras

Cardiol. 2009;92(4):326-30.

Steinberg BA, Zhao Y, He X, Hernandez AF, Fullerton DA, Thomas KL, et al. Management of postoperative atrial fibrillation and subsequent outcomes in contemporary patients undergoing cardiac surgery: insights from the Society of Thoracic Surgeons CAPS-Care Atrial Fibrillation Registry. Clin Cardiol. 2014;37(1):7-13.

Mahoney EM, Thompson TD, Veledar E, Williams J, Weintraub WS. Cost-effectiveness of targeting patients undergoing cardiac surgery for therapy with intravenous amiodarone to

prevent atrial fibrillation. J Am Coll Cardiol. 2002;40(4):737-45.

Silva RG da, Lima GG de, Guerra N, Bigolin AV, Petersen LC. Proposta de escore de risco para predição de fibrilação atrial após cirurgia cardíaca. Rev Bras Cir Cardiovasc. 2010;25(2):183-19.

Creswell LL, Schuessler RB, Rosenbloom M, Cox JL. Hazards of postoperative atrial arrhythmias. Ann Thoruc Surg. 1993;56(3):539-49.

Angelini P, Feldman MI, Lufschanowski R, Leachman RD. Cardiac arrhythmias during and after heart surgery: diagnosis and management. Prog Cardiovasc Dis. 1974;16(5):469-95.

Albahrani MJ, Swaminathan M, Phillips-Bute B, Smith PK, Newman MF, Mathew JP, et al. Postcardiac surgery complications: association of acute renal dysfunction and

atrial fibrillation. Anesth Analg. 2003;96(3):637-43.

Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk

factor-based approach: the Euro Heart Survey on atrial fibrillation. Chest. 2010;137(2):263-72.

Hosmer DW, Lemeshow S. Applied logistic regression. New York: John Wiley; 1989.

Mathew JP, Parks R, Savino JS, Friedman AS, Koch C, Mangano DT, et al. Atrial fibrillation following coronary artery bypass graft surgery: predictors, outcomes, and

resource utilization. MultiCenter Study of Perioperative Ischemia Research Group. JAMA. 276(4):300–6.

Echahidi N, Mohty D, Pibarot P, Després J-P, O’Hara G, Champagne J, et al. Obesity and metabolic syndrome are independent risk factors for atrial fibrillation after

coronary artery bypass graft surgery. Circulation. 2007;116(11 Suppl):I213-9.

Osranek M, Fatema K, Qaddoura F, Al-Saileek A, Barnes ME, Bailey KR, et al. Left atrial volume predicts the risk of atrial fibrillation after cardiac surgery: a prospective study. J Am

Coll Cardiol. 2006;48(4):779-86.

Sabzi F, Zokaei AH, Moloudi AR. Predictors of atrial fibrillation following coronary artery bypass grafting. Clin Med Insights Cardiol. 2011;5:67-75.


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(8):793-801. https://doi.


Maisel WH, Rawn JD, Stevenson WG. Atrial fibrillation after cardiac surgery. Ann Intern Med. 2001;135(12):1061.

Nazeri A, Razavi M, Elayda MA, Lee V-V, Massumi A, Wilson JM, et al. Race/ethnicity and the incidence of new-onset atrial fibrillation after isolated coronary artery bypass

surgery. Hear Rhythm. 2010;7(10):1458-63.

Siebert J. Atrial fibrillation after coronary artery bypass grafting without cardiopulmonary bypass. Eur J Cardio-Thoracic Surg. 2000;17(5):520-3.

Helgadottir S, Sigurdsson MI, Ingvarsdottir IL, Amar DO, Gudbjartsson T. Atrial fibrillation following cardiac surgery: risk analysis and long-term survival. J Cardiothorac Surg. 2012;7(1):87-93.

Kannel WB, Abbott RD, Savage DD, McNamara PM. Epidemiologic features of chronic atrial fibrillation. N Engl J Med. 1982;306(17):1018-22.


Yadava M, Hughey AB, Crawford TC. Postoperative atrial fibrillation: incidence, mechanisms, and clinical correlates. Cardiol Clin. 2014;32(4):627-36.

Crystal E, Garfinkle MS, Connolly SS, Ginger TT, Sleik K, Yusuf SS. Interventions for preventing post-operative atrial fibrillation in patients undergoing heart surgery. Cochrane

Database Syst Rev. 2004;18(4):CD003611.

Andrews TC, Reimold SC, Berlin JA, Antman EM. Prevention of supraventricular arrhythmias after coronary artery bypass surgery. A meta-analysis of randomized control

trials. Circulation. 1991;84(5 Suppl):III236-44.

Mathew JP, Fontes ML, Tudor IC, et al. A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA. 2004;291(14):1720-9.

LaPar DJ, Speir AM, Crosby IK, et al. Postoperative atrial fibrillation significantly increases mortality, hospital readmission, and hospital costs. Ann Thorac

Surg. 2014;98(2):527-33; discussion 533.

Almassi GH, Schowalter T, Nicolosi AC, Aggarwal A, Moritz TE, Henderson WG, et al. Atrial fibrillation after cardiac surgery: a major morbid event? Ann Surg. 1997;226(4):501-11.

Fuller JA, Adams GG, Buxton B. Atrial fibrillation after coronary artery bypass grafting. Is it a disorder of the elderly? J Thorac Cardiovasc Surg. 1989;97(6):821-5.

Silva RG, Lima GG, Laranjeira A, Costa AR, Pereira E, Rodrigues R. Fatores de risco e morbimortalidade associados à fibrilação atrial no pós-operatório de cirurgia cardíaca.

Arq Bras Cardiol. 2004;83:99-104.

Clinical Arrythmia