How to predict postoperative atrial fibrillation after cardiac surgery

Abstract

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The prediction and management of postoperative atrial fibrillation (POAF) remain areas yet to be fully elucidated. Rizza and colleagues recently unveiled a connection between several factors, notably the preoperative neutrophil‐to‐lymphocyte ratio (NLR), and the emergence of subacute POAF in patients undergoing cardiac surgery followed by cardiac rehabilitation.1 Nevertheless, certain critical considerations have been raised.

It is imperative to provide more comprehensive baseline characteristics associated with atrial fibrillation (AF) to accurately estimate the risk of AF occurrence and its prognostic impact. Such parameters encompass a patient's history of catheter ablation for AF, the administration of anti‐arrhythmic agents and anticoagulants, as well as the evaluation of the CHADS2 score. Notably, patients with a history of paroxysmal AF are widely recognized as being at an escalated risk of AF recurrence and should ideally be excluded from analyses.

The etiology of POAF is multifaceted, intertwined with postsurgical disruptions to the autonomic and inflammatory systems, cytokine cascades, and oxidative stress.2 Intriguingly, the authors highlighted the impact of preoperative NLR.1 It would greatly benefit the readership if the authors could elucidate the mechanistic underpinnings behind how preoperative parameters influence the incidence of POAF. Additionally, there exists a cadre of other proposed biomarkers predictive of POAF, such as high‐sensitivity C‐reactive protein, markers related to oxidative stress, and uric acid.3

Moreover, there is a pressing need to explore the long‐term clinical outcomes associated with POAF. The recurrence of AF frequently manifests in patients who have experienced POAF, thereby influencing mortality and morbidity.4

CONFLICT OF INTEREST STATEMENT

Authors declare no conflict of interests for this article.