Postsurgical Atrial Fibrillation Increases Heart Attack Risk

A new study suggests that postoperative atrial fibrillation (POAF) can significantly increase the risk of heart attack or stroke during the year after surgery.

Researchers at Loyola University Medical Center (Maywood, IL, USA) examined the Healthcare Cost and Utilization Project (HCUP) inpatient databases for California and Florida, identifying 4,345 patients who underwent radical cystectomy between 2007 and 2010, of whom 210 (4.8%) developed POAF. After excluding patients with a prior history of atrial fibrillation (AF), coronary artery disease, and/or stroke, the patients were matched for age, race, insurance status, and preexisting comorbidities.

The researchers then assessed the effect of POAF on cardiovascular events over the first year postoperatively. The results showed that among those patients who developed POAF, 24.8% experienced a heart attack or stroke during the first 12 months after surgery. By comparison, less than half (10.9%) of the patients who did not experience POAF experienced a myocardial infarct (MI) or stroke during the first year. The study was published ahead of print on April 3, 2015, in the Journal of Urology.

“Our results demonstrate that patients undergoing radical cystectomy who develop transient postoperative atrial fibrillation are at a significantly increased risk of cardiovascular events within the first postoperative year,” concluded lead author Robert Blackwell, MD, and colleagues. “Physicians should be vigilant in assessing postoperative atrial fibrillation, even when transient, and establish appropriate follow-up, given the increased risk of cardiovascular morbidity.”

POAF following radical cystectomy occurs in 2%–8% of cases, and is also the most frequent complication following cardiovascular surgery. Conventional viewpoints suggest that POAF is less likely to affect the survival of patients when compared with chronic AF, although it does slightly prolong the duration of hospital stay. However, newer reports suggest that POAF is associated with a significantly higher incidence of various complications, including cardiovascular events, renal failure, infection, and cerebral infarction.

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