Incidence and predictors of postoperative atrial fibrillation following coronary artery bypass graft surgery: a meta-analysis of 207 studies

Background Postoperative atrial fibrillation (POAF) is one of the most common tachyarrhythmias after coronary artery bypass graft (CABG) surgery. This study aimed to determine the overall incidence and predictors of POAF after CABG surgery through a systematic review of existing research findings.Methods The protocol of this study was registered in PROSPERO (CRD420251023423) and written under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Results 207 articles with a total sample size of 180,223 participants were included in our meta-analysis. The overall incidence of POAF following CABG surgery was 24% (95% CI 23%–26%). Increased age and male gender were associated with higher odds of developing POAF (ORs of 1.06 and 1.28, respectively, p < 0.01). Comorbidities, including congestive heart failure (CHF), hypertension, COPD, renal failure, and chronic kidney disease (CKD), were shown to be predictors of POAF. Those who do not use beta-blocker or have withdrawn from it were more likely to experience POAF (OR = 2.26, 95% CI 1.35–3.78, p < 0.01). Preoperative use of statins significantly reduced the odds of POAF (OR = 0.57, 95% CI 0.42–0.78, p < 0.01). On-pump surgery, grafting ≥ 3 vessels, longer length of stay in hospital, use of intra-aortic balloon pump (IABP), prolonged cross-clamp time, use of inotropic medications, and higher left atrial volume index (LAVI), and LA diameter were also predictors of POAF. Higher preoperative left ventricular ejection fraction (LVEF) was another factor that was associated with lower odds of developing POAF.Conclusion Recognising the risk factors for POAF helps us to identify high-risk patients to provide better preventive measures and management strategies for POAF after CABG.