Impact of pre-operative factors on post-operative atrial fibrillation outcomes after cardiac surgery: systematic review with meta-analysis, trial sequential analysis, and meta-regression

OBJECTIVES: Post-operative atrial fibrillation (POAF) is the most common arrhythmia following cardiac surgery. We conducted a systematic review and meta-analysis to quantify the association between POAF and adverse outcomes. METHODS: We searched PubMed, Embase, CENTRAL, and Web of Science through December 2024. Studies comparing outcomes between POAF and non-POAF patients after cardiac surgery were included. Random-effects meta-analysis was performed. Trial sequential analysis, Bayesian analysis, subgroup analyses, and meta-regression were conducted. Evidence certainty was assessed using the GRADE framework. RESULTS: =0%). Trial sequential analysis confirmed conclusive evidence for all outcomes. Bayesian posterior probability was 100% for all outcomes. GRADE certainty was moderate for early mortality, late mortality, and AKI; low for stroke. Meta-regression identified prior stroke prevalence and chronic kidney disease as significant effect modifiers. CONCLUSIONS: POAF is associated with substantially increased risks of mortality, stroke, and acute kidney injury following cardiac surgery. These findings support evidence-based prevention strategies and comprehensive management of POAF.