Perioperative AF increases the risk of ischemic stroke

by Joseph Esherick, M.D., FAAFP, FHM

Perioperative AF during noncardiac surgery increases the risk of ischemic stroke 3.5-fold within 12 months.  Usually considered secondary to the stress of surgery, perioperative AF was associated with elevated risk for ischemic stroke 1 year later.

 

Perioperative atrial fibrillation (AF) is common in cardiac surgery and is also seen in noncardiac surgery. Because AF is thought to be secondary to local inflammation (pericardial) in cardiac surgery and generalized stress in cardiac and noncardiac surgery, it is not considered to increase the risk for stroke once the stress of surgery has resolved.

Using a large, California State database of 1,729,360 patients hospitalized for surgery, investigators compared the long-term outcomes of patients with and without perioperative AF. Patients with preoperative AF were excluded from the analysis.

New-onset AF occurred in 24,711 patients (1.43%) during the perioperative period and was more common in cardiac surgery (16.10%) compared with noncardiac surgery (0.78%). During a mean follow-up of 2.1 years, 13,952 patients experienced an ischemic stroke. At 1 year of follow-up in the cardiac surgery group, the incidence of stroke was 0.99% in those with perioperative AF and 0.83% in those without perioperative AF (hazard ratio, 1.3; 95% confidence interval, 1.1–1.6). The association was stronger in the noncardiac surgery group (incidence of stroke, 1.47% vs. 0.36% in patients with vs. without perioperative AF; HR, 2.0; 95% CI, 1.7–2.3).

 

Atrial fibrillation during surgery 

Gialdini G et al. Perioperative atrial fibrillation and the long-term risk of ischemic stroke. JAMA 2014 Aug 13; 312:616.