Brunetta Enrico, Del Monaco Guido, Rodolfi Stefano, Zachariah Donah, Vlachos Kostantinos, Latini Alessia Chiara, De Santis Maria, Ceriotti Carlo, Galimberti Paola, Taormina Antonio, Battaglia Vincenzo, Falasconi Giulio, Maceda Diego Penela, Efremidis Michael, Letsas Konstantinos P, Selmi Carlo, Stefanini Giulio Giuseppe, Condorelli Gianluigi, Frontera Antonio
Unit of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital Rozzano Italy.
Arrhythmology Department, IRCCS Humanitas Research Hospital Rozzano Italy.
J Arrhythm. 2024 May 19;40(4):815-821. doi: 10.1002/joa3.13058. eCollection 2024 Aug.
Atrial fibrillation (AF) represents the most common arrhythmia in the postoperative setting. We aimed to investigate the incidence of postoperative AF (POAF) and determine its predictors, with a specific focus on inflammation markers.
We performed a retrospective single tertiary center cohort study including consecutive adult patients who underwent a major surgical procedure between January 2016 and January 2020. Patients were divided into four subgroups according to the type of surgery.
Among 53,387 included patients (79.4% male, age 64.5 ± 9.5 years), POAF occurred in 570 (1.1%) with a mean latency after surgery of 3.4 ± 2.6 days. Ninety patients died (0.17%) after a mean of 13.7 ± 8.4 days. The 28-day arrhythmia-free survival was lower in patients undergoing lung and cardiovascular surgery ( < .001). Patients who developed POAF had higher levels of C-reactive protein (CRP) (0.70 ± 0.03 vs. 0.40 ± 0.01 log10 mg/dl; < .001). In the multivariable Cox regression analysis, adjusting for confounding factors, CRP was an independent predictor of POAF [HR per 1 mg/dL increase in log-scale = 1.81 (95% CI 1.18-2.79); = .007]. Moreover, independent predictors of POAF were also age (HR/1 year increase = 1.06 (95% CI 1.04-1.08); I < .001), lung and cardiovascular surgery (HR 23.62; (95% CI 5.65-98.73); < .001), and abdominal and esophageal surgery (HR 6.26; 95% CI 1.48-26.49; = .013).
Lung and cardiovascular surgery had the highest risk of POAF in the presented cohort. CRP was an independent predictor of POAF and postsurgery inflammation may represent a major driver in the pathophysiology of the arrhythmia.
心房颤动（AF）是术后最常见的心律失常。我们旨在调查术后房颤（POAF）的发生率并确定其预测因素，特别关注炎症标志物。
我们进行了一项回顾性单中心队列研究，纳入了2016年1月至2020年1月期间连续接受大手术的成年患者。根据手术类型将患者分为四个亚组。
在纳入的53387例患者中（男性占79.4%，年龄64.5±9.5岁），570例（1.1%）发生了POAF，术后平均延迟时间为3.4±2.6天。90例患者（0.17%）在平均13.7±8.4天后死亡。接受肺部和心血管手术的患者28天无心律失常生存率较低（<0.001）。发生POAF的患者C反应蛋白（CRP）水平较高（0.70±0.03对0.40±0.01 log10 mg/dl；<0.001）。在多变量Cox回归分析中，校正混杂因素后，CRP是POAF的独立预测因素[对数尺度每增加1 mg/dL的HR = 1.81（95%CI 1.18 - 2.79）；P = 0.007]。此外，POAF的独立预测因素还包括年龄（每增加1岁的HR = 1.06（95%CI 1.04 - 1.08）；P < 0.001）、肺部和心血管手术（HR 23.62；（95%CI 5.65 - 98.73）；P < 0.001）以及腹部和食管手术（HR 6.26；95%CI 1.48 - 26.49；P = 0.013）。
在所呈现的队列中，肺部和心血管手术发生POAF的风险最高。CRP是POAF的独立预测因素，术后炎症可能是心律失常病理生理学的主要驱动因素。
