Obesity and Risk of New-Onset Atrial Fibrillation After Cardiac Surgery
- 22 November 2005
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 112 (21), 3247-3255
- https://doi.org/10.1161/circulationaha.105.553743
Abstract
Background— New-onset postoperative atrial fibrillation (AF) is a common complication of cardiac surgery that has substantial effects on outcomes. In the general (nonsurgical) adult population, AF has been linked to increasing obesity, which correlates with left atrial enlargement. It is not known whether postoperative AF is similarly linked to obesity. Methods and Results— This was a retrospective analysis of the incidence of AF in terms of body mass index (BMI). A total of 8051 consecutive cardiac surgery patients (1994 to 2004; mean age 64 [SD 11] years; 5372 men [67%]) who were free of any history of preoperative AF or flutter were included in the analysis. This series included 3164 obese patients (39%; median age 62 years) and 4887 nonobese patients (61%; median age 66 years), who were further divided on the basis of BMI (kg/m 2 ) into 6 groups: BMI 2 , 22≤BMI≤25 kg/m 2 (normal), 252 (overweight), 302 (obese I), 3540 kg/m 2 (obese III). Unadjusted AF incidence was similar in obese and nonobese patients (n=742 [23.5%] versus n=1068 [21.9%], respectively; P =0.099). Covariate-adjusted ORs for AF were systematically greater for larger patients than for patients in the normal group (adjusted OR [95% CI]=1.18 [1.00 to 1.40], 1.36 [1.14 to 1.63], 1.69 [1.35 to 2.11], and 2.39 [1.81 to 3.17] for overweight, obese I, obese II, and obese III, respectively). Other AF predictors included age (adjusted OR=1.52 [95% CI 1.46 to 1.58] per 10 years), mitral valve surgery (adjusted OR=2.42 [95% CI 1.92 to 3.06]), aortic valve surgery (adjusted OR=1.79 [95% CI 1.45 to 2.22]), chronic obstructive pulmonary disease (adjusted OR=1.28 [95% CI 1.12 to 1.46]), male gender (adjusted OR=1.24 [95% CI 1.10 to 1.40]), preoperative β-blocker use (adjusted OR=1.17 [95% CI 1.05 to 1.32]), vascular disease (adjusted OR=1.18 [95% CI 1.05 to 1.32]), white race (adjusted OR=1.33 [95% CI 1.07 to 1.66]), history of arrhythmia other than AF/flutter (adjusted OR=0.80 [95% CI 0.68 to 0.96]), ejection fraction Conclusions— Obesity is an important determinant of new-onset AF after cardiac surgery. Future postoperative AF risk models should incorporate BMI or obesity levels. Studies examining the efficacy of AF-minimizing prophylactic interventions in high-BMI patients, particularly in the elderly, may be warranted.Keywords
This publication has 24 references indexed in Scilit:
- Effects of Obesity and Small Body Size on Operative and Long-Term Outcomes of Coronary Artery Bypass Surgery: A Propensity-Matched AnalysisThe Annals of Thoracic Surgery, 2005
- Clinical prediction rule for atrial fibrillation after coronary artery bypass graftingJournal of the American College of Cardiology, 2004
- Postoperative atrial fibrillation and mortality after coronary artery bypass surgeryJournal of the American College of Cardiology, 2004
- Left atrial volume as an index ofleft atrial size: a population-based studyJournal of the American College of Cardiology, 2003
- A Comparison of Rate Control and Rhythm Control in Patients with Atrial FibrillationNew England Journal of Medicine, 2002
- Influence of Excess Fat on Cardiac Morphology and Function: Study in Uncomplicated ObesityObesity Research, 2002
- Randomized, Controlled Trials, Observational Studies, and the Hierarchy of Research DesignsNew England Journal of Medicine, 2000
- Obesity is associated with increased myocardial oxidative stressInternational Journal of Obesity, 1999
- Atrial Fibrillation After Cardiac SurgeryAnnals of Surgery, 1997
- Atrial fibrillation following coronary artery bypass surgeryProgress in Cardiovascular Diseases, 1989