title: Atrial fibrillation postcardiac surgery: a common but a morbid complication.
abstract: OBJECTIVE
  Despite all the advances in cardiac surgery, atrial fibrillation (AF) remains a common postoperative complication with unclear predisposing factors. Postoperative AF is often a short-lived and a self-limiting condition, but can result in debilitating and even lethal consequences. The aim of this study is to assess the effect of AF on patients postcardiac surgery.
  
  
  METHODS
  In this retrospective study, we prospectively reviewed patient data for our institution for a 10-year period; a total of 17,379 patients with preoperative sinus rhythm (SR) who underwent cardiac surgery were included, of which 4984 (28.7%) had developed postoperative AF for any length of time. After propensity matching for the preoperative characteristics between the two groups; the group with AF and the group who remained in SR, postoperative complications, in-hospital mortality, mid-term survival rate (five years), and long-term survival rate (10 years) were compared.
  
  
  RESULTS
  Before and after adjusting for the preoperative characteristics and type of the operation, postoperative complications, such as renal failure, surgical wound infection, stroke and myocardial infarction were significantly higher in the AF group compared to the SR group (P < 0.001). Inotropic support, use of intra-aortic balloon pump, and ventilation time were also considerably higher in the AF patients (P < 0.001). In-hospital mortality was also higher in the AF group. Likewise, 30-day, mid-term and long-term mortality rates were found to be considerably higher in the AF group.
  
  
  CONCLUSIONS
  Despite all the modern anti-arrhythmic drugs, the incidence of AF remains unchanged. Patients who develop AF postcardiac surgery show a significantly worse outcome compared to those without AF. This study also highlights the importance of anticoagulation in AF to prevent the devastating consequences as a result of a cerebral stroke. We believe that not only immediate treatment of AF postoperatively should be implemented, but also measures should be taken to identify the risk factors of AF and to prevent AF postcardiac surgery.
authors.affiliation: Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool L14 3PE, UK. saina.attaran@kcl.ac.uk
authors.forename: Saina
authors.initials: S
authors.lastname: Attaran
authors.forename: Matthew
authors.initials: M
authors.lastname: Shaw
authors.forename: Laura
authors.initials: L
authors.lastname: Bond
authors.forename: Mark D
authors.initials: MD
authors.lastname: Pullan
authors.forename: Brian M
authors.initials: BM
authors.lastname: Fabri
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D004739:England; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants