Heart flutter in surgery presages stroke risk

Can atrial fibrillation (AF) or flutter during surgery predict stroke? Research published in the Aug. 13 issue of JAMA appears to confirm that it does.

While a better understanding of stroke risk exists for patients with chronic AF, questions remain about the risks for stroke for patients who only present a flutter when undergoing surgery.

Using data on nonfederal healthcare facilities collected by the California Office of Statewide Health Planning and Development, Gino Gialdini, MD, of Weill Cornell Medical College in New York City, and colleagues sought to find risk patterns for surgical patients who were not diagnosed with AF when admitted. The cohort was collected from patients undergoing surgery from January 2007 to December 2010.

The team found that rates for stroke after perioperative AF were higher if the patient was not undergoing heart surgery. However, regardless of the type of surgery, risks were higher in these AF patients than those without. Rates for stroke in perioperative AF patients were 1.47 percent after noncardiac surgery and 0.99 percent after cardiac surgery at one year. Meanwhile, for patients who did not present with AF during surgery, rates of stroke following noncardiac surgery were 0.36 percent and 0.83 percent following cardiac surgery after one year.

Gialdini et al reported the hazard ratio for perioperative AF patients following noncardiac and cardiac surgery as being 2 and 1.3, respectively.

They wrote that further studies were needed to determine risks associated with perioperative AF, both transient and persistent, to help shape optimal strategies for therapy for these patients to reduce future stroke risks.