Abstract

Risk factors and clinical impact of new-onset atrial fibrillation following cardiac surgery: A single-centre prospective study in Yemen

Author(s): Ismail Al-Shameri, Abudar Al-ganadi, Ahmed Hailan, Sedqi Alkubati, Feras Almghizel, Sabia Obeed, Salem Bashraheel, Naseem Al-wsabi, Nada Al-wsabi

Background: New-onset Postoperative Atrial Fibrillation (POAF) is a common arrhythmic complication after cardiac surgery, associated with increased morbidity, prolonged hospital stays, and elevated resource utilization. We conducted this study to identify preoperative, intraoperative, and postoperative risk factors associated with POAF and to assess its clinical outcomes among patients undergoing cardiac surgery. Methods: We conducted a prospective observational study on 210 consecutive adult patients who underwent cardiac surgery at our tertiary center in Yemen. Patients were grouped into POAF (n=32, 15.2%) and non-POAF (n=178, 84.8%) cohorts. Multivariable logistic regression was used to identify independent risk factors. Results: POAF occurred in 32 patients (15.2%). Posterior pericardiotomy was found to be a significant protective factor against POAF (OR=0.388, 95% CI: 0.184 0.820, p=0.013). No significant differences were observed in age, gender, or baseline comorbidities between groups. However, POAF was significantly associated with adverse postoperative outcomes, including longer ICU stay (27.0 vs 24.0 hours, p=0.036), higher rates of pericardial effusion (75.0% vs 15.2%, p<0.001), cardiac tamponade (15.6% vs 2.8%, p=0.002), pulmonary complications (18.8% vs 5.1%, p=0.006), and renal impairment (18.8% vs 6.7%, p=0.025). Additionally, POAF was associated with significantly increased risk of re-exploration (12.5% vs 2.2%, p=0.005), postoperative stroke (9.4% vs 1.1%, p=0.001), congestive heart failure (12.5% vs 2.2%, p = 0.005), and overall adverse events (18.8% vs 2.2%, p=0.001). Hospital mortality was also notably higher in the POAF group (9.4% vs 1.1%, p=0.001), and median hospital stay was prolonged (7.0 vs 6.0 days, p=0.001). Conclusion: New-onset POAF following cardiac surgery is associated with a significantly increased risk of life-threatening complications and in-hospital mortality.