Perioperative atrial arrhythmias in noncardiothoracic patients: a review of risk factors and treatment strategies in the veteran population

Am J Surg. 2010 Nov;200(5):601-5. doi: 10.1016/j.amjsurg.2010.07.019.


Background: Perioperative atrial arrhythmias (PAAs) in noncardiothoracic patients have poorly defined risk factors and management.

Methods: The surgical intensive care unit database was queried for patients who developed PAAs from 2008 to 2009. Demographics, comorbidities, preoperative data (electrocardiography, chest x-rays, laboratory results), medications, intraoperative variables, management, and outcomes of atrial arrhythmias were collected. Controls were randomly chosen in a 3:1 ratio. Comparisons were performed using χ² tests, Student's t tests, or nonparametric comparisons as appropriate. Multivariate logistic regression was performed.

Results: Five hundred sixty-one patients were admitted to the surgical intensive care unit. Three hundred fifty-four (63%) had noncardiothoracic surgery, and 30 (8.5%) developed PAAs. The mean age of patients with PAAs was 66 ± 7.3 years, compared with 64 ± 11 years for controls (P = NS), with most patients undergoing general (60%) and vascular (33%) surgery. PAA patients were more likely to have coronary artery disease (P = .029), cardiomegaly (P = .011), and premature atrial contractions (P = .016) and to take aspirin (P = .010). On multivariate logistic regression, predictors of atrial arrhythmias were premature atrial contractions, preoperative hypokalemia, intraoperative adverse events, and cardiomegaly. Most PAA patients received amiodarone (63%). Ten percent required electrical cardioversion, and 26% received anticoagulation. PAA patients had significantly longer intensive care unit lengths of stay (P = .032).

Conclusion: Coronary artery disease, cardiomegaly, hypokalemia, and premature atrial contractions were significantly associated with PAAs in noncardiothoracic patients. Prospective studies are needed to define treatment guidelines.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Amiodarone / therapeutic use
  • Anti-Arrhythmia Agents / therapeutic use*
  • Atrial Fibrillation / epidemiology*
  • Atrial Fibrillation / etiology
  • Atrial Fibrillation / therapy
  • Electric Countershock / methods*
  • Follow-Up Studies
  • Hospital Mortality / trends
  • Hospitals, Veterans
  • Humans
  • Incidence
  • Intensive Care Units
  • Length of Stay
  • Middle Aged
  • Perioperative Period*
  • Practice Guidelines as Topic*
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Surgical Procedures, Operative / adverse effects*
  • United States / epidemiology
  • Veterans*


  • Anti-Arrhythmia Agents
  • Amiodarone