Atrial fibrillation in perioperative period in noncardiac surgery

Background. Episodes of atrial fibrillation (AF) occurring in perioperative period, especially during non-cardiac surgery, can lead to destabilization of hemodynamics, aggravate the patient’s condition, prolong hospitalization and trigger acute coronary syndrome, heart failure and stroke. 

Objective. To identify the predictors of paroxysmal atrial fibrillation arising in perioperative period during non-cardiac surgery, using the preoperative examination data.

Material and methods. 1051 patients who were yet to undergo abdominal, urological and articular surgeries were used for the analysis. These patients had no history of AF in their anamnesis. Preoperative examination was performed: clinical examination, electrocardiogram (ECG) at rest, 24-hour ECG monitoring, echocardiography (EchoCG), including the evaluation of myocardial deformation using the Speckle Tracking method (STE); cardiopulmonary exercise test (CPX) and in a number of patients - coronary angiography.

Results. Paroxysmal AF was registered in 61 patients (5.8% of all patients included in the study). Majority (81.9%) of the episodes of AF appeared in the first 5 days after the surgery. In the perioperative period, episodes of AF were regarded as the main cause of 25% of all nonfatal myocardial infarctions (MI), 27% of fatal MI and every second episode of acute cerebrovascular accident. Patients with AF significantly more often had a history of diabetes (31.2 vs 13.6%, OR 2.9, р=0.02) and hypertension (82.0 vs 60.9%, OR 2.9, р=0.02). Significantly, more often, AF developed after surgery for oncological pathologies of the abdominal cavity. The results of the EchoCG showed that the development of perioperative episodes of AF was associated with more than 40 ml/m2 increase in the index volume of the left atrium (in 17.0% of patients with AF versus 7.5% in patients without AF, OR 2.5, р<0.01).

Conclusion. During non-cardiac surgery in patients with diabetes mellitus, hypertension, with an increase in the volume of the left atrium greater than 40 ml/m2, as well as before surgery for oncological pathologies of the abdominal cavity, the risk of paroxysmal atrial fibrillation in the perioperative period is significantly higher.

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