Preexisting Atrial Fibrillation Predicts Worse Cardiac Outcomes After Noncardiac Surgery

[MJZaw]

Interesting study...

consultqd-clevelandclinic-o...

[Maggimunro]

That is potentially bad news for anyone with AF who then needs say a hip replacement. Has this paper been peer reviewed?

[frazeej in reply to Maggimunro]

Unclear to me if this study has been published in a peer reviewed journal, or is just part of a "newsletter" format. BUT, Cleveland Clinic is a top performer, and I would give substantial credit to their findings.

[JOY2THEWORLD49]

HiI have had two operations since being diagnosed with stroke,with AF and Papillary Thyroid Cancer.

2 operations were total thyroidectomy with 12 lymph nodes removed in Feb 2020 and removal of Johnson & Johnson horrid mesh in TVT Kit which did damage.

In both operations I had 2 anaesthetists in the room.

With the. latter there were 2 drs as well. Also the specialist wanted this done in a DHB public hospital as against a private hospital where I would not the support.

Neither would have operated with H/R of over 100.

I reminded both that at night my H/R is 47!

After the latter operation and damage and inflammation rid of my energy flowed in which hadn't had since the Stroke and AF.

My question does inflammation cause AF and energy loss. I am aware that problem with Thyroid e.g low or high or cancer there causes AF.

cheri JOY 73. (NZ)

[mjames1]

This kind of got buried in the study -- "Patients with AF had more comorbidities, which may at least partially account for the increased risk."

So it appears that the cohorts were not very well matched, so not surprising. Along this line of thought, afib may have had nothing to do with it, so not really sure how they are coming up with afib as an independent factor as comorbidities differ patient to patient.

Jim

[frazeej in reply to mjames1]

In my opinion, there is a great deal of undiagnosed PAF lurking out there, and in their sample selection for the "normal" side of the study, there in fact could be an unknown number of "secret and silent" PAF folks........which would tend to equalize the risk numbers between the two study groups. I don't know how to overcome this possible obstacle to the data reliability, as PAF by it's very nature often remains undiagnosed.

[mjames1 in reply to frazeej]

Agreed but I don't think enough to equalize risk factors between the two groups.

[mav7]

Thanks for posting, MJ. Informative article.

Preoperative AF was also associated with higher risks of systemic embolism and major bleeding at 30 days and with longer median hospital stay (P < 0.001 for all).

“For example, whether atrial fibrillation was paroxysmal, persistent or permanent could not be assessed in this study and may provide additional insight,” notes co-author and Cleveland Clinic electrophysiologist Shady Nakhla, MD. He adds that ejection fraction, left atrial volume and medication history and use during hospitalization were also not considered.

Seems the purpose of the study was to insure AF was included as a risk factor for non cardiac surgery. Hard to realize it had been omitted. I feel most surgeons would have considered AF but may not have realized these stats.

Also, note two key points above. Bleeding can be an issue but gives no indication of when anticoagulants were discontinued before surgery.

And the overall condition of the heart was not considered. Study seems to raise more questions than answers other than the importance of including AF as a risk factor.

[MJZaw in reply to mav7]

Insightful commentary Mav; The problem I have is the failure to isolate the many variables associated with the health of the population included in the study. Nonetheless, while not proving causation, the study is thought provoking for those of us with Afib.

[DawnTX]

Not good to see. I have major dental and back surgery ahead

[MJZaw in reply to DawnTX]

I had dental surgery last year. The dentist suggested the I not take Eliquis for three days prior. However, she wisely reached out to the cardiologist and he changed that to 2 days. The procedure was non-eventful. I was supposed to have an implant surgically installed but I opted not to do that ... don't like the idea of any invasive medical procedure unless absolutely necessary. Good luck going forward.

[DawnTX in reply to MJZaw]

Until this last procedure I was always taken off Xarelto for two days. My new Doctor Who is both my EP and cardiologist told me no need to stop. I had very little blood loss during the surgery and that might be why. I am hoping to have four screws put in but nothing is certain right now as I still cannot have anything done at this time. I also have a laminectomy that needs to be done. It was supposed to be done last October but it seems like each time I’m about to get it by a fib rears its ugly head. This last situation has been the worst and the longest time to heal. I do know however that I am getting better. Thank you for your reply

[Ablation7 in reply to DawnTX]

I’ve had several dental surgeries since being diagnosed. Never an issue. I do ask for No or low epinephrine in the Novocain.

[DawnTX in reply to Ablation7]

That is good to hear because the dental needs to be done. My first a fib event sent me down to the floor unconscious facedown so I have surgery that must be done. I am going to have general anesthesia. Thank you for saying that about not having problems.