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(Circulation. 2005;112:3247-3255.)
© 2005 American Heart Association, Inc.

Cardiovascular Surgery

Obesity and Risk of New-Onset Atrial Fibrillation After Cardiac Surgery

Anoar Zacharias, MD; Thomas A. Schwann, MD; Christopher J. Riordan, MD; Samuel J. Durham, MD; Aamir S. Shah, MD; Robert H. Habib, PhD

From the Division of Cardiovascular Surgery, St. Vincent Mercy Medical Center (A.Z., T.A.S., C.J.R., S.J.D., A.S.S., R.H.H.), Toledo, Ohio; Division of Cardiovascular Surgery, St. Luke’s Hospital (A.Z., T.A.S., C.J.R., S.J.D., A.S.S., R.H.H.), Maumee, Ohio; and Departments of Surgery (A.Z., T.A.S., C.J.R., S.J.D., A.S.S.) and Medicine (R.H.H.), Medical University of Ohio, Toledo, Ohio.

Correspondence to Robert H. Habib, PhD, Director, Cardiopulmonary Research, St. Vincent Mercy Medical Center, 2213 Cherry St, ACC Bldg, Suite 309, Toledo, OH 43608. E-mail Robert_Habib{at}mhsnr.org

Received April 4, 2005; revision received August 30, 2005; accepted September 1, 2005.

Background— New-onset postoperative atrial fibrillation (AF) is a common complication of cardiac surgery that has substantial effects on outcomes. In the general (nonsurgical) adult population, AF has been linked to increasing obesity, which correlates with left atrial enlargement. It is not known whether postoperative AF is similarly linked to obesity.

Methods and Results— This was a retrospective analysis of the incidence of AF in terms of body mass index (BMI). A total of 8051 consecutive cardiac surgery patients (1994 to 2004; mean age 64 [SD 11] years; 5372 men [67%]) who were free of any history of preoperative AF or flutter were included in the analysis. This series included 3164 obese patients (39%; median age 62 years) and 4887 nonobese patients (61%; median age 66 years), who were further divided on the basis of BMI (kg/m²) into 6 groups: BMI <22 kg/m², 22BMI25 kg/m² (normal), 25<BMI30 kg/m² (overweight), 30<BMI 35 kg/m² (obese I), 35<BMI40 kg/m² (obese II), and BMI >40 kg/m² (obese III). Unadjusted AF incidence was similar in obese and nonobese patients (n=742 [23.5%] versus n=1068 [21.9%], respectively; P=0.099). Covariate-adjusted ORs for AF were systematically greater for larger patients than for patients in the normal group (adjusted OR [95% CI]=1.18 [1.00 to 1.40], 1.36 [1.14 to 1.63], 1.69 [1.35 to 2.11], and 2.39 [1.81 to 3.17] for overweight, obese I, obese II, and obese III, respectively). Other AF predictors included age (adjusted OR=1.52 [95% CI 1.46 to 1.58] per 10 years), mitral valve surgery (adjusted OR=2.42 [95% CI 1.92 to 3.06]), aortic valve surgery (adjusted OR=1.79 [95% CI 1.45 to 2.22]), chronic obstructive pulmonary disease (adjusted OR=1.28 [95% CI 1.12 to 1.46]), male gender (adjusted OR=1.24 [95% CI 1.10 to 1.40]), preoperative ß-blocker use (adjusted OR=1.17 [95% CI 1.05 to 1.32]), vascular disease (adjusted OR=1.18 [95% CI 1.05 to 1.32]), white race (adjusted OR=1.33 [95% CI 1.07 to 1.66]), history of arrhythmia other than AF/flutter (adjusted OR=0.80 [95% CI 0.68 to 0.96]), ejection fraction <40% (adjusted OR=1.16 [95% CI 1.03 to 1.31]), left main disease (adjusted OR=1.15 [95% CI 1.00 to 1.32]), and off-pump surgery (adjusted OR=0.61 [95% CI 0.44 to 0.83]). The obesity-AF association was confirmed in 4 1-to-1 propensity-matched obese versus nonobese comparisons and in 2 separate derivation/validation subcohort analyses.

Conclusions— Obesity is an important determinant of new-onset AF after cardiac surgery. Future postoperative AF risk models should incorporate BMI or obesity levels. Studies examining the efficacy of AF-minimizing prophylactic interventions in high-BMI patients, particularly in the elderly, may be warranted.

Key Words: arrhythmia • cardiopulmonary bypass • complications • multivariate analysis • propensity matching

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