Atrial fibrillation in vascular surgery: a systematic review and meta-analysis on prevalence, incidence and outcome implications

Abstract

Aims To know the prevalence of atrial fibrillation (AF), as well as the incidence of postoperative AF (POAF) in vascular surgery for arterial diseases and its outcome implications. Methods We performed a systematic review and meta-analysis following the PRISMA statement. Results After the selection process, we analyzed 44 records (30 for the prevalence of AF history and 14 for the incidence of POAF). The prevalence of history of AF was 11.5% [95% confidence interval (CI) 1–13.3] with high heterogeneity (I 2 = 100%). Prevalence was higher in the case of endovascular procedures. History of AF was associated with a worse outcome in terms of in-hospital death [odds ratio (OR) 3.29; 95% CI 2.66–4.06; P < 0.0001; I 2 94%] or stroke (OR 1.61; 95% CI 1.39–1.86; P < 0.0001; I 2 91%). The pooled incidence of POAF was 3.6% (95% CI 2–6.4) with high heterogeneity (I 2 = 100%). POAF risk was associated with older age (mean difference 4.67 years, 95% CI 2.38–6.96; P = 0.00007). The risk of POAF was lower in patients treated with endovascular procedures as compared with an open surgical procedure (OR 0.35; 95% CI 0.13–0.91; P = 0.03; I 2 = 61%). Conclusions In the setting of vascular surgery for arterial diseases a history of AF is found overall in 11.5% of patients, more frequently in the case of endovascular procedures, and is associated with worse outcomes in terms of short-term mortality and stroke. The incidence of POAF is overall 3.6%, and is lower in patients treated with an endovascular procedure as compared with open surgery procedures. The need for oral anticoagulants for preventing AF-related stroke should be evaluated with randomized clinical trials.