Authors: Gialdini G et al., JAMA 2014 Aug 13; 312:616
Usually considered secondary to the stress of surgery, perioperative AF was associated with elevated risk for ischemic stroke 1 year later.
Perioperative atrial fibrillation (AF) is common in cardiac surgery and is also seen in noncardiac surgery. Because AF is thought to be secondary to local inflammation (pericardial) in cardiac surgery and generalized stress in cardiac and noncardiac surgery, it is not considered to increase the risk for stroke once the stress of surgery has resolved.
Using a large, California State database of 1,729,360 patients hospitalized for surgery, investigators compared the long-term outcomes of patients with and without perioperative AF. Patients with preoperative AF were excluded from the analysis.
New-onset AF occurred in 24,711 patients (1.43%) during the perioperative period and was more common in cardiac surgery (16.10%) compared with noncardiac surgery (0.78%). During a mean follow-up of 2.1 years, 13,952 patients experienced an ischemic stroke. At 1 year of follow-up in the cardiac surgery group, the incidence of stroke was 0.99% in those with perioperative AF and 0.83% in those without perioperative AF (hazard ratio, 1.3; 95% confidence interval, 1.1–1.6). The association was stronger in the noncardiac surgery group (incidence of stroke, 1.47% vs. 0.36% in patients with vs. without perioperative AF; HR, 2.0; 95% CI, 1.7–2.3).
Comment — Cardiology
Perioperative AF increases the risk for stroke twofold at 1 year after noncardiac surgery. Presumably, this increased risk for stroke is secondary to AF during follow-up. The occurrence of perioperative AF, especially in patients undergoing noncardiac surgery, should be taken seriously. Although the results of this study do not justify long-term anticoagulation in all patients with perioperative AF, they do support close follow-up for the development of non-perioperative AF in order to continue or begin anticoagulation.