Incidence and complications of perioperative atrial fibrillation after non-cardiac surgery for malignancy
Incidence and complications of perioperative atrial fibrillation after non-cardiac surgery for malignancy
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DOI：
10.1371/journal.pone.0216239
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发表时间：
2019-05-07
期刊：
影响因子：
3.7
通讯作者：
Yoshino, Hideaki
中科院分区：
文献类型：
--
作者：
Higuchi, Satoshi;Kabeya, Yusuke;Yoshino, Hideaki
围手术期心房颤动（POAF）是恶性肿瘤非心脏手术中常见的心律失常之一。由于POAF可能会导致随后的不良事件，重要的是要确认其特点和危险因素。Materials and MethodsThe前瞻性队列研究围手术期房颤复发（预测房颤复发）的监测是一个正在进行的前瞻性，单中心，观察性研究，旨在说明POAF的临床影响，在重大非心脏手术恶性肿瘤。登记了计划因确诊/疑似恶性肿瘤接受非心脏手术的患者。排除有房颤和房扑病史的患者。任何30天并发症包括急性心肌梗死、充血性心力衰竭、出血、血栓形成、任何感染和急性肾损伤。主要终点是POAF.ResultsThe本研究包括799例患者（年龄，68 +/- 11;男性，62%）的发病率。其中，80例患者（10.0%）发生POAF。值得注意的是，66名患者（83%）没有症状。180例患者（23%）发生了任何30天并发症（POAF：34例（43%）;无POAF：146例（20%）; p < 0.001）。17例（50%）POAF发生前有并发症，无一例发生心源性休克和/或急性心力衰竭。采用多变量校正模型分析术后30天并发症与术后房颤发生之间的关系（优势比：2.84; 95%可信区间：1.74-4.62; p < 0.001）。由于大多数患者无症状，因此使用心电图监测进行仔细观察非常重要，以避免疏忽。临床试验注册UMIN ID：UMIN 000016146
BackgroundPerioperative atrial fibrillation (POAF) is one of the common arrhythmias in the setting of non-cardiac surgeries for malignancy. As POAF may cause subsequent adverse events, it is important to confirm its characteristics and risk factors.Materials and methodsThe prospective cohort study of surveillance for perioperative atrial fibrillation recurrence (PREDICT AF RECURRENCE) is an ongoing prospective, single-center, observational study that aims to illustrate the clinical impact of POAF in major non-cardiac surgery for malignancy. Patients who planned to undergo non-cardiac surgery for definitive/suspected malignancy were registered. Those with a history of AF and atrial flutter were excluded. Any 30-day complications included acute myocardial infarction, congestive heart failure, bleeding, thrombosis, any infection, and acute kidney injury. The primary endpoint was an incidence of POAF.ResultsThe present study included 799 patients (age, 68 +/- 11; male, 62%). Of these, 80 patients (10.0%) developed POAF. Notably, 66 patients (83%) had no symptoms. Any 30-day complications occurred in 180 patients (23%) (with POAF: 34 (43%); without POAF: 146 (20%); p < 0.001). POAF in 17 patients (50%) was preceded by the development of complications.No patient developed cardiogenic shock and/or acute heart failure. The association between 30-day complications and POAF development were analyzed using the multivariate adjusted model (odds ratio: 2.84; 95% confidence interval: 1.74-4.62; p < 0.001).ConclusionTen percent of patients who underwent non-cardiac surgery for malignancy developed POAF, which was strongly associated with perioperative complications. As a majority were asymptomatic, careful observation using electrocardiography monitoring is important to avoid oversights.Clinical trial registrationUMIN ID: UMIN000016146