Inflammation in new‐onset atrial fibrillation after cardiac surgery: a systematic review

Background Postoperative new‐onset atrial fibrillation ( PNAF ) is the most common complication following cardiac surgery. The pathogenesis of PNAF is multifactorial. The concept of the postoperative inflammatory response, as a potential underlying mechanism has been extensively studied. This review aims to provide a comprehensive summary of literature relevant to the association between the inflammatory response following cardiac surgery and PNAF . Design MEDLINE , EMBASE and the Cochrane Central Register were systematically reviewed by two independent investigators for studies published between J anuary 1980 and M ay 2012, in which an association between serum markers of inflammation and PNAF was evaluated, or the effect of drugs with anti‐inflammatory properties on the risk of PNAF . Results Sixty‐three studies met selection criteria (39 observational and 24 randomized studies) including 27 363 patients. The mean incidence of PNAF after cardiac surgery was 25·5%. Elevated levels of various inflammatory mediators were associated with PNAF , and the most consistent association was found between white blood cell count and PNAF . Of the drugs with anti‐inflammatory properties, statins gave the best protective effect against PNAF , followed by anti‐oxidants, steroids and colchicine. Nonsteroidal anti‐inflammatory drugs did not prevent PNAF significantly. Conclusion The postoperative inflammation response may play a role in the pathogenesis of PNAF . However, of the inflammation biomarkers, only elevated white blood cell count reliably predicts PNAF . Pre‐ and perioperative use of statins and several other drugs with anti‐inflammatory properties reduce the incidence of PNAF .