Incidence and risk factors for new-onset atrial fibrillation following coronary artery bypass grafting : A systematic review and meta-analysis

Objectives
To estimate the incidence of new-onset post-operative atrial fibrillation after isolated coronary artery bypass surgery and summarise the evidence on risk factors that predispose people to developing the complication.

Study design/methods
A systematic review was conducted to identify studies from the CINAHL, MEDLINE and Cochrane databases. A title and abstract review was conducted by one reviewer. Full text review and quality assessment processes were conducted by two reviewers. Incidence data was combined in meta-analysis using the ‘metaprop’ routine in Stata and risk factor data were synthesised in narrative and table format.

Results
Ten studies, including 6173 participants, were included in the review. The estimated pooled incidence of post-operative atrial fibrillation was 25% (CI 0.19–0.30). In a secondary meta-analysis including studies that only included first time bypass surgery recipients the estimated pooled incidence was 26% (CI 0.14–0.41). Due to high levels of heterogeneity these results should be interpreted with caution. Risk factors with the strongest associations to post-operative atrial fibrillation were chronic obstructive pulmonary disease, decreased partial pressure of oxygen on air, congestive heart failure, right coronary artery disease, male gender, prolonged cross clamp time and port-operative inotropic exposure.

Conclusion
Further prospective studies are needed to strengthen the current evidence base.

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