Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Department of Medicine, McMaster University, Hamilton, ON, Canada.
Can J Anaesth. 2021 Jul;68(7):1045-1056. doi: 10.1007/s12630-021-01944-0. Epub 2021 Feb 23.
This systematic review aimed to summarize reports of the incidence and long-term recurrence of new-onset atrial fibrillation (AF) associated with non-cardiac surgery.
We searched CENTRAL, MEDLINE and EMBASE from inception to November 2019. We included studies that reported on the incidence of new-onset perioperative AF during hospitalization for non-cardiac surgery and/or AF recurrence in such patients following discharge. Reviewers screened articles and abstracted data independently and in duplicate. We assessed study quality by appraising methodology for collecting AF history, incident AF during hospitalization, and AF recurrence after discharge.
From 39,233 citations screened, 346 studies that enrolled a total of 5,829,758 patients met eligibility criteria. Only 27 studies used prospective, continuous inpatient electrocardiographic (ECG) monitoring to detect incident AF. Overall, the incidence of postoperative AF during hospitalization ranged from 0.004 to 50.3%, with a median [interquartile range] of 8.7 [3.8-15.0]%. Atrial fibrillation incidence varied with type of surgery. Prospective studies using continuous ECG monitoring reported significantly higher incidences of AF than those that did not (13.9% vs 1.9%, respectively; P < 0.001). A total of 13 studies (25,726 patients) with follow-up up to 5.4 years reported on AF recurrence following hospital discharge; only one study used a prospective systematic monitoring protocol. Recurrence rates ranged from 0 to 37.3%.
Rates of AF incidence first detected following non-cardiac surgery and long-term AF recurrence vary markedly. Differences in the intensity of ECG monitoring and type of surgery may account for this variation.
PROSPERO (CRD42017068055); registered 1 September 2017.
本系统评价旨在总结与非心脏手术相关的新发心房颤动（AF）的发生率和长期复发的报告。
我们从建库到 2019 年 11 月检索了 CENTRAL、MEDLINE 和 EMBASE。我们纳入了报告非心脏手术后住院期间新发围手术期 AF 以及出院后此类患者 AF 复发的发生率的研究。审查员独立并重复筛选文章和提取数据。我们通过评估收集 AF 病史、住院期间发生 AF 以及出院后 AF 复发的方法学来评估研究质量。
从筛选出的 39233 篇文献中，共有 346 项研究纳入了总共 5829758 名患者，符合入选标准。只有 27 项研究使用前瞻性、连续住院心电图（ECG）监测来检测新发 AF。总的来说，住院期间术后 AF 的发生率为 0.004 至 50.3%，中位数[四分位距]为 8.7[3.8-15.0]%。AF 发生率随手术类型而异。使用连续 ECG 监测的前瞻性研究报告的 AF 发生率明显高于未使用连续 ECG 监测的研究（分别为 13.9%和 1.9%；P<0.001）。共有 13 项研究（25726 名患者）随访时间长达 5.4 年，报告了出院后 AF 的复发情况；只有一项研究使用了前瞻性系统监测方案。复发率从 0 到 37.3%不等。
首次在非心脏手术后发现的 AF 发生率和长期 AF 复发率差异很大。心电图监测的强度和手术类型的差异可能是造成这种差异的原因。
PROSPERO（CRD42017068055）；注册日期为 2017 年 9 月 1 日。
