Vol 25, No 1-2 (2023)
Review paper
Published online: 2024-09-13
Preparing a patient with atrial fibrillation for non-cardiac surgery
DOI: 10.5603/chp.97603
Chirurgia Polska 2023;25(1-2):48-54.
Abstract
Atrial fibrillation (AF) is the most common arrhythmia worldwide and poses a significant public health challenge. Patients with AF who require surgery present a clinical challenge. This article reviews issues related to preparing AF patients for non-cardiac surgery (NCS). The ABC approach can be implemented to optimize the preparation of AF patients for NCS, which involves stroke prevention (anticoagulation therapy), symptom control, and management of comorbidities. Anticoagulation therapy significantly reduces the risk of stroke in AF patients, and the choice of anticoagulant depends on bleeding risk and creatinine clearance. Discontinuation of anticoagulation therapy before surgery may be necessary and depends on the type of procedure and the specific anticoagulant used. Heart rhythm or rate control are two strategies for managing AF patients. Early rhythm control therapy can improve the quality of life for patients and reduce the risk of adverse cardiovascular outcomes. However, precise patient monitoring and “tailored” treatment are crucial. Preparing AF patients for non-cardiac surgery requires a comprehensive risk assessment and individualized approach. The clinical value of AF, bleeding risk, and the type of surgery and anesthesia should be considered to improve surgical outcomes for AF patients.
Keywords: atrial fibrillationnon-cardiac surgeryanticoagulation
References
- Hindricks G, Potpara T, Dagres N, et al. Wytyczne ESC 2020 dotyczące diagnostyki i leczenia migotania przedsionków opracowane we współpracy z European Association of Cardio‑Thoracic Surgery (EACTS). Kardiol Pol (Polish Heart Journal. 2021; 79(II): 8–144.
- Colilla S, Crow A, Petkun W, et al. Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population. Am J Cardiol. 2013; 112(8): 1142–1147.
- Krijthe BP, Kunst A, Benjamin EJ, et al. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J. 2013; 34(35): 2746–2751.
- Hall MJ, Schwartzman A, Zhang J, et al. Ambulatory surgery data from hospitals and ambulatory surgery centers: united states, 2010. Natl Health Stat Report. 2017(102): 1–15.
- Karamchandani K, Khanna AK, Bose S, et al. Atrial fibrillation: current evidence and management strategies during the perioperative period. Anesth Analg. 2020; 130(1): 2–13.
- Cohn SL. The cardiac consult for patients undergoing non-cardiac surgery. Heart. 2016; 102(16): 1322–1332.
- Halvorsen S, Mehilli J, Cassese S, et al. Wytyczne ESC 2022 dotyczące oceny ryzyka sercowo-naczyniowego i postępowania u pacjentów poddawanych operacjom niekardiochirurgicznym. Eur Hear J. 2022; 43(39): 3826–3924.
- Kaatz S, Douketis JD, Zhou H, et al. Risk of stroke after surgery in patients with and without chronic atrial fibrillation. J Thromb Haemost. 2010; 8(5): 884–890.
- Cho MS, Lee CH, Kim J, et al. Clinical implications of preoperative nonvalvular atrial fibrillation with respect to postoperative cardiovascular outcomes in patients undergoing non-cardiac surgery. Korean Circ J. 2020; 50(2): 148–159.
- Prasada S, Desai MY, Saad M, et al. Preoperative atrial fibrillation and cardiovascular outcomes after noncardiac surgery. J Am Coll Cardiol. 2022; 79(25): 2471–2485.
- Curtis AB, Korada SK. Should atrial fibrillation be included in Preoperative risk assessment for noncardiac surgery? J Am Coll Cardiol. 2022; 79(25): 2486–2488.
- Tafur AJ, Clark NP, Spyropoulos AC, et al. Predictors of bleeding in the perioperative anticoagulant use for surgery evaluation study. J Am Heart Assoc. 2020; 9(19): e017316.
- Mitrega K, Lip G, Sredniawa B, et al. Predicting silent atrial fibrillation in the elderly: a report from the NOMED-AF cross-sectional study. J Clin Med. 2021; 10(11): 2321.
- Steffel J, Collins R, Antz M, et al. External reviewers. 2021 european heart rhythm association practical guide on the use of non-vitamin k antagonist oral anticoagulants in patients with atrial fibrillation. Europace. 2021; 23(10): 1612–1676.
- Kietaibl S, Ferrandis R, Godier A, et al. Regional anaesthesia in patients on antithrombotic drugs: Joint ESAIC/ESRA guidelines. Eur J Anaesthesiol. 2022; 39(2): 100–132.
- Douketis J, Spyropoulos A, Kaatz S, et al. Perioperative bridging anticoagulation in patients with atrial fibrillation. N Engl J Med. 2015; 373(9): 823–833.
- Beyer-Westendorf J, Gelbricht V, Förster K, et al. Peri-interventional management of novel oral anticoagulants in daily care: results from the prospective Dresden NOAC registry. Eur Heart J. 2014; 35(28): 1888–1896.
- Pollack CV, Reilly PA, van Ryn J, et al. Idarucizumab for dabigatran reversal — full cohort analysis. N Engl J Med. 2017; 377(5): 431–441.
- Connolly SJ, Crowther M, Eikelboom JW, et al. ANNEXA-4 Investigators. Full Study Report of Andexanet Alfa for Bleeding Associated with Factor Xa Inhibitors. N Engl J Med. 2019; 380(14): 1326–1335.
- Bradshaw PG, Keegan SP, Droege ME, et al. Reversal of apixaban and rivaroxaban with andexanet alfa prior to invasive or surgical procedures. Pharmacotherapy. 2022; 42(10): 780–791.
- Teiger E, Thambo J, Defaye P, et al. Percutaneous left atrial appendage closure is a reasonable option for patients with atrial fibrillation at high risk for cerebrovascular events. Circ Cardiovasc Interv. 2018; 11(3): e005841.
- Willems S, Borof K, Brandes A, et al. Systematic, early rhythm control strategy for atrial fibrillation in patients with or without symptoms: the EAST-AFNET 4 trial. Eur Heart J. 2022; 43(12): 1219–1230.
- Sethi NJ, Feinberg J, Nielsen EE, et al. The effects of rhythm control strategies versus rate control strategies for atrial fibrillation and atrial flutter: a systematic review with meta-analysis and trial sequential analysis. PLoS One. 2017; 12(10): e0186856.
- Ha AC, Breithardt G, Camm AJ, et al. Health-related quality of life in patients with atrial fibrillation treated with rhythm control versus rate control: insights from a prospective international registry (registry on cardiac rhythm disorders assessing the control of atrial fibrillation: RECORD-AF). Circ Cardiovasc Qual Outcomes. 2014; 7(6): 896–904.
- Camm AJ, Naccarelli GV, Mittal S, et al. The increasing role of rhythm control in patients with atrial fibrillation: JACC state-of-the-art review. J Am Coll Cardiol. 2022; 79(19): 1932–1948.
- Farkowski MM, Maciąg A, Żurawska M, et al. Rapid pharmacological cardioversion of recent-onset atrial fibrillation using antazoline in elderly patients. Pol Arch Intern Med. 2022; 132(1): 16120.
- Wybraniec MT, Kampka Z, Mizia-Stec K. Pharmacological cardioversion of atrial fibrillation: practical considerations. Pol Arch Intern Med. 2023; 133(9): 16547.
- Lévy S. Cardioversion of recent-onset atrial fibrillation using intravenous antiarrhythmics: A European perspective. J Cardiovasc Electrophysiol. 2021; 32(12): 3259–3269.
- McIntyre W, Healey J, Bhatnagar A, et al. Vernakalant for cardioversion of recent-onset atrial fibrillation: a systematic review and meta-analysis. EP Europace. 2019; 21(8): 1159–1166.
- Um K, McIntyre W, Healey J, et al. Pre- and post-treatment with amiodarone for elective electrical cardioversion of atrial fibrillation: a systematic review and meta-analysis. Europace. 2019; 21(6): 856–863.
- Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016; 37(38): 2893–2962.
- Brandes A, Crijns HJ, Rienstra M, et al. Cardioversion of atrial fibrillation and atrial flutter revisited: current evidence and practical guidance for a common procedure. Europace. 2020; 22(8): 1149–1161.
- Smilowitz NR, Berger JS. Perioperative cardiovascular risk assessment and management for noncardiac surgery: a review. JAMA. 2020; 324(3): 279–290.
- Sagris M, Vardas EP, Theofilis P, et al. Atrial fibrillation: pathogenesis, predisposing factors, and genetics. Int J Mol Sci. 2021; 23(1).
- Rienstra M, Hobbelt AH, Alings M, et al. et al.. Targeted therapy of underlying conditions improves sinus rhythm maintenance in patients with persistent atrial fibrillation: results of the. Eur Heart J. 2018; 39(32): 2987–2996.
- Wsół A, Braksator W. Przygotowanie pacjenta obciążonego kardiologicznie do operacji pozasercowej. Kardiologia po Dyplomie. 2012; 11(6): 50–56.
- Oesterle A, Weber B, Tung R, et al. Preventing postoperative atrial fibrillation after noncardiac surgery: a meta-analysis. Am J Med. 2018; 131(7): 795–804.e5.
- Bedford J, Garside T, Darbyshire J, et al. Risk factors for new-onset atrial fibrillation during critical illness: A Delphi study. J Intensive Care Soc. 2022; 23(4): 414–424.
- Czapla M, Uchmanowicz I, Juárez-Vela R, et al. Relationship between nutritional status and length of hospital stay among patients with atrial fibrillation — a result of the nutritional status heart study. Front Nutr. 2022; 9: 1086715.