Postoperative Atrial Fibrillation after Cardiac Surgery: A Review of Risk Factors, Clinical Outcomes, and Management Strategies

Introduction: Postoperative atrial fibrillation (POAF) is the most common arrhythmia following cardiac surgery and is associated with increased postoperative complications, longer hospital stay, and higher mortality. Early identification of factors contributing to prolonged POAF may facilitate timely intervention and reduce postoperative adverse events. Objective: To evaluate the demographic and clinical characteristics of patients with POAF and to determine the association between the duration of arrhythmia and the extent of coronary artery disease. Materials and methods: Between January 1, 2020 and December 31, 2023, a total of 2,419 cardiac surgeries were performed at Zan Mitrev Clinic, Skopje. The study included all patients over 18 years of age who developed POAF after any type of cardiac surgical procedure (aorto-coronary bypass, valvular, aortic, or combined surgery). Patients with a previous history of atrial fibrillation or without adequate follow-up were excluded. Medical records and discharge summaries were retrospectively reviewed from the Hospital Information System (HIS) and outpatient follow-up visits up to one year after surgery. Patients were divided into two groups according to the duration of POAF: <48 hours and ≥48 hours. Statistical analysis was performed using SPSS software, version 26.0 (IBM, Chicago, USA), applying Pearson Chi-square, Fisher exact, and Mann–Whitney U tests, with a significance level set at p<0.05. Results: The analysis included 378 patients with POAF, of whom 268 (70.9%) were male. Mean age did not differ significantly between groups (65.67±8.91 vs. 66.47±7.56 years; p=0.7004), nor did BMI (p=0.3384). No statistically significant differences were observed regarding diabetes mellitus, hyperlipidemia, COPD, arterial hypertension, or glomerular filtration rate. Only multivessel coronary artery disease (CAD) was significantly more common among patients with POAF ≥48 hours (57.84% vs. 48.18%; χ²=8.891; df=3; p=0.0308). Conclusion: Multivessel CAD is a significant predictor of prolonged postoperative atrial fibrillation following cardiac surgery. Keywords: postoperative atrial fibrillation, coronary artery disease, multivessel CAD, cardiac surgery