Post-operative atrial fibrillation after cardiac surgery: a systematic review and meta-analysis.

Abstract Background Post-operative atrial fibrillation (POAF) after cardiac surgery is associated with longer hospital stay and increased in-hospital stroke and mortality, but its longer-term implications remain incompletely understood. A systematic literature review was undertaken to investigate the impact of POAF on long-term mortality and stroke in adult cardiac surgery patients. Methods Electronic databases (Cochrane, EMBASE, Ovid Medline, PubMed) were queried from inception to October 2018. Included studies compared long-term outcomes in cardiac surgery patients with and without POAF. Adjusted and unadjusted meta-analyses examined mortality, stroke, and major adverse cardiac and cerebrovascular events. Risk of bias was evaluated with the Newcastle-Ottawa Scale. Results Thirty-two studies describing 155,575 cardiac surgery patients met inclusion criteria; 36,988 patients (23.7%) had POAF. Meta-analysis of 10 studies (44,367 patients) demonstrated increased one-year mortality in patients with POAF (odds ratio 2.60, 95% confidence interval 2-3.38; p Conclusions This systematic review and meta-analysis identified an association between POAF and long-term mortality after cardiac surgery. More comprehensive POAF prevention and management, including more stringent follow-up for POAF recurrence after hospital discharge, may be indicated. While included studies used inconsistent definitions of POAF and variable exclusion criteria, estimates of heterogeneity are low. Differences in preoperative comorbidities such as age, ejection fraction, and obesity may not be fully accounted for in adjusted analyses. Future work is required to delineate mechanisms linking POAF and mortality in this population.