Incidence and Characteristics of Postoperative Atrial Fibrillation in Sudanese Patients Undergoing Heart Valve Surgery: A Descriptive Retrospective Study
Published: 2023-06-19
Page: 224-231
Issue: 2023 - Volume 6 [Issue 1]
Mehad E. Abdelsalam
Department of Clinical Pharmacy, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan.
Kannan O. Ahmed
Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Gezira, Wad Medani, Sudan.
Safaa Badi
Department of Clinical Pharmacy, Faculty of Pharmacy, Omdurman Islamic University, Khartoum, Sudan.
Mohmmed A. Mohmmedahmed
Cardiology Unit, Sudan Heart Center, Khartoum, Sudan.
Bashir A. Yousef *
Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan.
*Author to whom correspondence should be addressed.
Abstract
Introduction: Postoperative atrial fibrillation (POAF) is one of most common complications in the hospital setting after cardiac surgery in general and valve surgery in particular. The incidence estimates POAF after valve surgery has been described to be as high as 50%. However, no study has done to assess the incidence of POAF it in Sudanese population. Thus, this study aimed to assess the incidence and risk factors of POAF in Sudanese patients undergoing heart valve surgery.
Methods: A descriptive retrospective hospital-based study was conducted at two governmental hospitals (Alshaab Teaching Hospital and Ahmed Gasim Cardiac Surgery and Renal transplantation Centre), Khartoum, Sudan. All patients undergoing valve surgery between Jan 2017 and March 2019 were included and reviewed, and checklist was used to collect data, then descriptive and inferential statistics were analyzed using SPSS.
Results: POAF incidence in patients undergoing valve surgery was 39.9% (164/411). The majority of them (56.1%), were females, and the highest population (47.6%) were aged 41-60 years. Mitral valve surgery was the most frequent (61%) site of valve surgery. Moreover, among the independent variables, age, and the site of valve surgery were statistically significant (P-value ˂ 0.05) associated with POAF development. Bisoprolol was the most frequently used medication to manage POAF. Heart failure was the most frequent complication of POAF (29.3%) followed by death (25.6%).
Conclusion: The incidence of POAF is 39.9%. Age and the site of valve surgery were significantly associated with POAF in patients undergoing heart valve surgery. Moreover, prevention and treatment against POAF were suboptimal.
Keywords: Postoperative atrial fibrillation, heart valve surgery, Bisoprolol, mitral valve surgery
How to Cite
References
Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42(5):373-498. DOI: 10.1093/eurheartj/ehaa612
Eikelboom R, Sanjanwala R, Le ML, Yamashita MH, Arora RC. Postoperative atrial fibrillation after cardiac surgery: A systematic review and meta-analysis. Ann Thorac Surg. 2021;111(2):544-54. DOI: 10.1016/j.athoracsur.2020.05.104
Abdelmoneim SS, Rosenberg E, Meykler M, Patel B, Reddy B, Ho J et al. The incidence and natural progression of new-onset postoperative atrial fibrillation. JACC Clin Electrophysiol. 2021;7(9):1134-44. DOI: 10.1016/j.jacep.2021.02.005
Iliescu AC, Salaru DL, Achitei I, Grecu M, Floria M, Tinica G. Postoperative atrial fibrillation prediction following isolated surgical aortic valve replacement. Anatol J Cardiol. 2018;19(6):394-400. DOI: 10.14744/AnatolJCardiol.2018.70745
ElSayed A, Elnur EE. The rebirth of cardiac surgery in Sudan. Cardiovasc Diagn Ther. 2016;6;Suppl 1:S20-6.
DOI: 10.21037/cdt.2016.10.02
Mokhtar MH, Eltayeb EM, Mesiri A. Evaluation of thromboprophylaxis therapy in non-valvular atrial fibrillation Sudanese patients. Int J Med Sci Public Health. 2018;7:566-70. DOI:10.5455/ijmsph.2018.0410415042018.
Suliman A, Alhasan N. Prevalence, Risk of thromboembolism and bleeding, and anticoagulation in patients with atrial fibrillation and stable coronary artery disease at Al Shab Teaching Hospital. Sudan Heart [journal]. 2014;1(2).
Greenberg JW, Lancaster TS, Schuessler RB, Melby SJ. Postoperative atrial fibrillation following cardiac surgery: a persistent complication. Eur J Cardiothorac Surg. 2017;52(4):665-72. DOI: 10.1093/ejcts/ezx039
Hashemzadeh K, Dehdilani M, Dehdilani M. Postoperative atrial fibrillation following Open Cardiac Surgery: predisposing Factors and Complications. J Cardiovasc Thorac Res. 2013;5(3):101-7. DOI: 10.5681/jcvtr.2013.022
Alawami M, Chatfield A, Ghashi R, Walker L. Atrial fibrillation after cardiac surgery: prevention and management: the Australasian experience. J Saudi Heart Assoc. 2018;30(1):40-6. DOI: 10.1016/j.jsha.2017.03.008
D’Agostino RS, Jacobs JP, Badhwar V, Fernandez FG, Paone G, Wormuth DW, et al. The Society of Thoracic Surgeons adult cardiac surgery database: 2018 update on outcomes and quality. Ann Thorac Surg. 2018;105(1):15-23.
DOI: 10.1016/j.athoracsur.2017.10.035
Chelazzi C, Villa G, De Gaudio AR. Postoperative atrial fibrillation. ISRN Cardiol. 2011;2011:203179. DOI: 10.5402/2011/203179
Kernis SJ, Nkomo VT, Messika-Zeitoun D, Gersh BJ, Sundt TM, 3rd, Ballman KV, et al. Atrial fibrillation after surgical correction of mitral regurgitation in sinus rhythm: incidence, outcome, and determinants. Circulation. 2004;110(16):2320-5. DOI:10.1161/01.CIR.0000145121.25259.54
Kalavrouziotis D, Buth KJ, Ali IS. The impact of new-onset atrial fibrillation on in-hospital mortality following cardiac surgery. Chest. 2007;131(3):833-9. DOI: 10.1378/chest.06-0735
Maranta F, Bonaccorso A, Rizza V, Pellegrino S, Meloni C, Avitabile M, et al. Subacute post-operative atrial fibrillation after valvular surgery in patients undergoing cardiac rehabilitation: predictive factors. Eur Heart J. 2020;41; Suppl 2. DOI: 10.1093/ehjci/ehaa946.3093.
Kalra R, Patel N, Doshi R, Arora G, Arora P. Evaluation of the incidence of new-onset atrial fibrillation after aortic valve replacement. JAMA Intern Med. 2019;179(8):1122-30. DOI: 10.1001/jamainternmed.2019.0205
Swinkels BM, de Mol BA, Kelder JC, Vermeulen FE, Ten Berg JM. New-onset postoperative atrial fibrillation after aortic valve replacement: effect on long-term survival. J Thorac Cardiovasc Surg. 2017;154(2):492-8. DOI: 10.1016/j.jtcvs.2017.02.052
Filardo G, Ailawadi G, Pollock BD, da Graca B, Phan TK, Thourani V, et al. Postoperative atrial fibrillation: sex-specific characteristics and effect on survival. J Thorac Cardiovasc Surg. 2020;159(4): 1419-1425.e1. DOI: 10.1016/j.jtcvs.2019.04.097
Amar D, Shi W, Hogue CW, Jr., Zhang H, Passman RS, Thomas B, et al. Clinical prediction rule for atrial fibrillation after coronary artery bypass grafting. J Am Coll Cardiol. 2004;6;44(6):1248- 53. DOI: 10.1016/j.jacc.2004.05.078
Mariscalco G, Biancari F, Zanobini M, Cottini M, Piffaretti G, Saccocci M, et al. Bedside tool for predicting the risk of postoperative atrial fibrillation after cardiac surgery: the POAF score. J Am Heart Assoc. 2014;3(2):e000752.
DOI: 10.1161/JAHA.113.000752
Asher CR, Miller DP, Grimm RA, Cosgrove DM, 3rd, Chung MK. Analysis of risk factors for development of atrial fibrillation early after cardiac valvular surgery. Am J Cardiol. 1998;82(7):892-5. DOI: 10.1016/s0002-9149(98)00498-6
Maisel WH, Rawn JD, Stevenson WG. Atrial fibrillation after cardiac surgery. Ann Intern Med. 2001;135(12):1061-73. DOI: 10.7326/0003-4819-135-12-200112180-00010
Aranki SF, Shaw DP, Adams DH, Rizzo RJ, Couper GS, VanderVliet M, et al. Predictors of atrial fibrillation after coronary artery surgery. Current trends and impact on hospital resources. Circulation. 1996;94(3):390-7. DOI: 10.1161/01.cir.94.3.390
Tadic M, Ivanovic B, Zivkovic N. Predictors of atrial fibrillation following coronary artery bypass surgery. Med Sci Monit. 2011;17(1):CR48-55. DOI: 10.12659/MSM.881329
Girerd N, Magne J, Pibarot P, Voisine P, Dagenais F, Mathieu P. Postoperative atrial fibrillation predicts long-term survival after aortic-valve surgery but not after mitral-valve surgery: a retrospective study. BMJ Open. 2011;1(2):e000385. DOI: 10.1136/bmjopen-2011-000385
Tanawuttiwat T, O’Neill BP, Cohen MG, Chinthakanan O, Heldman AW, Martinez CA, et al. New-onset atrial fibrillation after aortic valve replacement: comparison of transfemoral, transapical, transaortic, and surgical approaches. J Am Coll Cardiol. 2014;63(15):1510-9. DOI: 10.1016/j.jacc.2013.11.046
Ghurram A, Krishna N, Bhaskaran R, Kumaraswamy N, Jayant A, Varma PK. Patients who develop post-operative atrial fibrillation have reduced survival after off-pump coronary artery bypass grafting. Indian J Thorac Cardiovasc Surg. 2020; 36(1):6-13. DOI: 10.1007/s12055-019-00844-9
Amat-Santos IJ, Rodés-Cabau J, Urena M, DeLarochellière R, Doyle D, Bagur R, et al. Incidence, predictive factors, and prognostic value of new-onset atrial fibrillation following transcatheter aortic valve implantation. J Am Coll Cardiol. 2012;59(2):178-88. DOI: 10.1016/j.jacc.2011.09.061
Nombela-Franco L, Webb JG, de Jaegere PP, Toggweiler S, Nuis RJ, Dager AE, et al. Timing, predictive factors, and prognostic value of cerebrovascular events in a large cohort of patients undergoing transcatheter aortic valve implantation. Circulation. 2012;126(25):3041-53. DOI:10.1161/CIRCULATIONAHA.112.110981
Furuta A, Lellouche N, Mouillet G, Dhanjal T, Gilard M, Laskar M, et al. Prognostic value of new onset atrial fibrillation after transcatheter aortic valve implantation: a FRANCE 2 registry substudy. Int J Cardiol. 2016;210:72-9. DOI: 10.1016/j.ijcard.2016.02.073