Predicting post-operative atrial fibrillation after heart surgery: clinical profile and biomarkers

Abstract Objective Post-operative atrial fibrillation (POAF) is the most common arrhythmia after cardiac surgery, increasing the morbidity and mortality of this specific patient population. We investigated the association of clinical, biochemical and molecular markers on several tissues with the occurrence of POAF in patients undergoing coronary and/or valve surgery. Methods Between August 2020 and September 2022, patients undergoing cardiac surgery without previous history of AF were studied. Clinical variables were collected before the surgery, plasmatic samples and biological tissues (epicardial and subcutaneous fat) were obtained the day of surgery. We observed the development of POAF during the post-operative period. Logistic regression analyses were carried out in order to identify the predictors with better performance. Patients were followed-up until hospital discharge. Results Out of 123 consecutive patients without prior history of AF, 43 developed POAF during hospitalization. Significant clinical differences were associated with POAF, such higher EuroSCORE II, left atrial dimension and longer cardiopulmonary bypass times. Logistic regression analysis also showed orosomucoid (a biomarker associated with the inflammatory pathway) as the best predictor for POAF [odds ratio (OR) 7.175 (95% confidence interval (CI), 2.172-23.701), p=0,001]. Conclusions In patients referred for open heart surgery, orosomucoid at the moment of surgery is an independent risk factor for the development of POAF and its addition to EuroSCORE II increased the predictive ability.