Division of Cardiovascular Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham, and Women's Hospital, Harvard Medical School, Boston, MA.
J Cardiothorac Vasc Anesth. 2022 Mar;36(3):739-745. doi: 10.1053/j.jvca.2021.10.009. Epub 2021 Oct 13.
Atrial fibrillation after cardiac surgery (AFACS) is a serious postoperative complication. There is significant research interest in this field but also relevant heterogeneity in reported AFACS definitions and approaches used for its identification. Few data exist on the extent of this variation in clinical studies. The authors reviewed the literature since 2001 and included manuscripts reporting outcomes of AFACS in adults. They excluded smaller studies and studies in which patients did not undergo a sternotomy. The documented protocol in each manuscript was analyzed according to six different categories to determine how AFACS was defined, which techniques were used to identify it, and the inclusion and/or exclusion criteria. They also noted when a category was not described in the documented protocol. The authors identified 302 studies, of which 92 were included. Sixty-two percent of studies were randomized controlled trials. There was significant heterogeneity in the manuscripts, including the exclusion of patients with preoperative AF, the definition and duration of AF needed to meet the primary endpoint, the type of screening approach (continuous, episodic, or opportunistic), the duration of monitoring during the study period in days, the diagnosis with predefined electrocardiogram criteria, and the requirement for independent confirmation by study investigators. Furthermore, the definitions of these criteria frequently were not described. Consistent reporting standards for AFACS research are needed to advance scientific progress in the field. The authors here propose pragmatic standards for trial design and reporting standards. These include adequate sample size estimation, a clear definition of the AFACS endpoints, and a protocol for AFACS detection.
心脏手术后心房颤动（AFACS）是一种严重的术后并发症。该领域的研究兴趣浓厚，但报告的 AFACS 定义和用于识别 AFACS 的方法也存在相关的异质性。关于临床研究中这种差异的程度，几乎没有数据。作者回顾了 2001 年以来的文献，纳入了报告成人 AFACS 结局的文献。他们排除了较小的研究和未行胸骨切开术的患者的研究。根据六个不同类别分析每个文献中的记录方案，以确定 AFACS 是如何定义的，使用了哪些技术来识别它，以及纳入和/或排除标准。他们还注意到记录方案中未描述的类别。作者确定了 302 项研究，其中 92 项被纳入。62%的研究为随机对照试验。这些文献存在显著的异质性，包括排除术前有房颤的患者、需要满足主要终点的房颤定义和持续时间、筛查方法的类型（连续、偶发或机会性）、研究期间监测的持续时间（天数）、使用预先确定的心电图标准进行诊断，以及研究调查员需要独立确认。此外，这些标准的定义经常没有描述。需要为 AFACS 研究制定一致的报告标准，以推动该领域的科学进展。作者在此提出了试验设计和报告标准的实用标准。这些标准包括足够的样本量估计、AFACS 终点的明确定义以及 AFACS 检测方案。
