Incidence and Predictors of Postoperative Atrial Fibrillation After Cardiac Surgery

Key Takeaways

• POAF was reported across studies at 7.9% to 60.9%, with the highest rates in combined procedures and valve surgery.
• Recurring predictors included advanced age, left atrial enlargement, valve surgery, hypertension, diabetes, renal dysfunction, and prolonged cardiopulmonary bypass, with age showing an odds ratio of 1.05 to 1.10 per year.
• C-reactive protein, neutrophil-to-lymphocyte ratio, and NOX2 were associated signals, while MR-proANP and gene panels were described as potential tools alongside integrated risk models requiring multicenter validation.

Across recent studies, postoperative atrial fibrillation after adult cardiac surgery was reported in 7.9% to 60.9% of patients, highlighting how often it followed surgery. Rates appeared highest in combined procedures and valve surgery, although the overall pattern varied widely across operative settings, centers, and study populations. POAF was also linked with stroke, prolonged hospitalization, and mortality, making it a clinically important postoperative event across adult cardiac care. The review framed POAF as both common and multifactorial and focused on how often it occurred and which signals appeared most consistently.

In a PRISMA-guided systematic review, investigators examined English-language studies published from January 2020 through June 2025 in adults older than 18 years undergoing cardiac surgery. The search covered PubMed, Europe PMC, and SAGE. From 6,598 screened records, 52 studies met inclusion criteria, including 32 prospective cohorts, 17 retrospective cohorts, and 3 cross-sectional studies. Those studies represented diverse geographies and several surgical types, with coronary artery bypass grafting and valve surgery explicitly mentioned among the included procedures. The resulting evidence base was broad in scope and consisted largely of observational studies in adult postoperative cardiac populations.

Incidence findings remained heterogeneous across procedure categories, helping explain the wide variation across the included literature and surgical settings. The highest reported rates clustered in combined procedures at 40% to 50% and in valve surgery at 30% to 40%. Recurring predictors across cohorts included advanced age, left atrial enlargement, valve surgery, hypertension, diabetes, renal dysfunction, and prolonged cardiopulmonary bypass. Across these studies, age repeatedly tracked with higher odds, while patient comorbidity and procedural complexity also appeared regularly in association patterns. Clinical and operative signals recurred together throughout the reviewed evidence rather than appearing as isolated findings.

Biomarker-associated findings centered on inflammatory and oxidative stress signals, including C-reactive protein, neutrophil-to-lymphocyte ratio, and NOX2. MR-proANP and gene panels were also described as having potential among emerging tools in this evidence base. Authors characterized POAF as burdensome and multifactorial, reinforcing that no single clinical feature accounted for the observed postoperative pattern across studies. Standardized monitoring and integrated risk models were presented as possible approaches to improve prediction and prevention, with further multicenter validation still needed. The report closed on the need for multicenter validation before those forward-looking strategies can be more firmly established.