The impact of post-operative atrial fibrillation on outcomes in coronary artery bypass graft and combined procedures

BACKGROUND Post-operative atrial fibrillation(POAF) is a common yet understudied clinical issue after coronary artery bypass graft(CABG) leading to higher mortality rates and stroke. This systematic review and meta-analysis evaluated the rates of adverse outcomes between patients with and without POAF in patients treated with CABG or combined procedures.METHODS The search period was from the beginning of Pub Med and Embase to May 18 th, 2020 with no language restrictions.The inclusion criteria were:(1) studies comparing new onset atrial fibrillation before or after revascularization vs. no new onset AF before or after revascularization. The outcomes assessed included all-cause mortality, cardiac death, cerebral vascular accident(CVA), myocardial infarction(MI), repeated revascularization, major adverse cardiac event(MACE), and major adverse cardiac and cerebrovascular events(MACCEs).RESULTS Of the 7,279 entries screened, 11 studies comprising of 57,384 patients were included. Compared to non-POAF,POAF was significantly associated with higher risk of all-cause mortality(Risk Ratio(RR) = 1.58; 95% Confidence Interval(CI):1.42-1.76, P < 0.000 01) with accompanying high level of heterogeneity(I2 = 62%).Conclusions Patients with POAF after CABG or combined procedures are at an increased risk of all-cause mortality or CVAs.Therefore, POAF after such procedures should be closely monitored and treated judiciously to minimize risk of further complications. While there are studies on POAF versus no POAF on outcomes, the heterogeneity suggests that further studies are needed.