Epidemiological and pathogenetic mechanisms of atrial fibrillation depending on concomitant pathology, coronary bypass grafting and post-new coronavirus infection

Authors: Sokolova N.Yu., Savel’eva E.A., Popov D.A., Martynova K.A.

Company: 1 Tver State Medical University, Tver’, Tver’ region, Russian Federation
2 Tver’ Regional Clinical Hospital, Tver’, Tver’ region, Russian Federation

For correspondence:  Sign in or register.

Type:  Reviews

DOI: https://doi.org/10.24022/1997-3187-2022-16-3-302-312

For citation: Sokolova N.Yu., Savel’eva E.A., Popov D.A., Martynova K.A. Epidemiological and pathogenetic mechanisms of atrial fibrillation depending on concomitant pathology, coronary bypass grafting and post-new coronavirus infection. Creative Cardiology. 2022; 16 (3): 302–12 (in Russ.). DOI: 10.24022/1997-3187-2022-16-3-302-312

Received / Accepted:  24.06.2022 / 19.08.2022

Keywords: atrial fibrillation postoperative atrial fibrillation coronary artery bypass grafting

Full text:  



Postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery, including coronary artery bypass grafting, which has great clinical and economic importance for the healthcare system. Despite the improvement of surgical tactics, anesthetic and care benefits, POAF incidence has been increasing over the past decade. The mechanisms of POAF are different. Chronic coronary artery disease and its frequent comorbidities such as arterial hypertension, obesity, diabetes mellitus and heart failure, – are associated with various structural and functional changes in the heart, contributing to electrical atrial remodeling. Today, such risk factors for POAF as age, enlarged left atrium, post heart valve surgery, and obesity are well known. A new coronovirus infection that occurred in the early postoperative period can also be a trigger for atrial fibrillation. Postoperative arrhythmias can worsen both hospital and long-term results of treatment, increase the length of the patient's stay in the hospital, and the risk of complications. This review updates the data on the pathogenesis, incidence and complications of POAF, taking into account the current epidemiological situation.


  1. Ardashev A.V. Clinical arrhythmology. Moscow; 2009 (in Russ.).
  2. Kirchhof P., Benussi S., Kotecha D., Ahlsson А., Atar D., Casadei B. et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur. Heart J. 2016; 37: 2893–962. DOI: 10.1093/ejcts/ezw313
  3. Singleton M.J., Imtiaz-Ahmad M., Kamel H., O’Neal W.T., Judd S.E., Howard V.J. et al. Association of atrial fibrillation without cardiovascular comorbidities and stroke risk: From the REGARDS Study. J. Am. Heart Assoc. 2020; 9 (12): e016380. DOI: 10.1161/JAHA.120.016380. Epub 2020 Jun 4.
  4. Conen D., Alonso-Coello P., Douketis J., Chan M.T.V., Kurz A., Sigamani A. et al. Risk of stroke and other adverse outcomes in patients with perioperative atrial fibrillation 1 year after non-cardiac surgery. Eur. Heart J. 2020; 41 (Issue 5): 645–51. DOI: 10.1093/eurheartj/ehz431
  5. Saxena A., Dinh D.T., Smith J.A., Shardey G.C., Reid C.M., Newcomb A.E. Usefulness of postoperative atrial fibrillation as an independent predictor for worse early and late outcomes after isolated coronary artery bypass grafting (multicenter Australian study of 19,497 patients). Am. J. Cardiol. 2012; 109: 219225. DOI: 10.1016/j.amjcard.2011.08.033
  6. Butt J.H., Xian Y., Peterson E.D., Olsen P.S., Rorth R., Gundlund A. et al. Long-term thromboembolic risk in patients with postoperative atrial fibrillation after coronary artery bypass graft surgery and patients with nonvalvular atrial fibrillation. JAMA Cardiol. 2018; 3: 417–24. DOI: 10.1001/jamacardio.2018.0405
  7. Mou L., Norby F.L., Chen L.Y., O’Neal W.T., Lewis T.T., Loehr L.R. et al. Lifetime risk of atrial fibrillation by race and socioeconomic status: ARIC study (Atherosclerosis Risk in Communities). Circ. Arrhythm. Electrophysiol. 2018; 11: e006350. DOI: 10.1161/CIRCEP.118.006350
  8. Andrade J.G., Deyell M.W., Verma A., Macle L., Khairy P. The Cryoballoon vs Irrigated Radiofrequency Catheter Ablation (CIRCA-DOSE) Study results in context. Arrhythm. Electrophysiol. Rev. 2020; 9 (1): 34–9. DOI: 10.15420/aer.2019.13
  9. Aronow W.S., Ahn C., Mercando A.D., Epstein S. Correlation of atrial fibrillation, paroxysmal supraventricular tachycardia, and sinus rhythm with incidences of new coronary events in 1,359 patients, mean age 81 years, with heart disease. Am. J. Cardiol. 1995; 75: 182–4. DOI: 10.1016/S0002- 9149(00)80074-0
  10. Louis D.W., Saad M., Vijayakumar S., Ilyas S., Kokkirala A., Aronow H.D. The cardiovascular manifestations of COVID-19. Cardiol. Clin. 2022; 40 (3): 277–85. DOI: 10.1016/j.ccl.2022.03.001
  11. Chen M., Xiao F., Kuai L., Zhou H., Jia Z., Liu M. et al. Outcomes of atrial fibrillation in patients with COVID-19 pneumonia: A systematic review and meta-analysis. Am. J. Emerg. Med. 2021; 50: 661–9. Published online 2021 Sep 24. DOI: 10.1016/j.ajem.2021.09.050
  12. Bakhai A., Darius H., De Caterina R., Smart A., Le Heuzey J.Y., Schilling R.J. et al. Characteristics and outcomes of atrial fibrillation patients with or without specific symptoms: results from the PREFER in AF registry. Eur. Heart J. Qual. Care Clin. Outcomes. 2016; 2: 299305. DOI: 10.1093/ehjqcco/qcw031
  13. Chao T.F., Liu C.J., Wang K.L., Lin Y.J., Chang S.L., Lo L.W. et al. Should atrial fibrillation patients with 1 additional risk factor of the CHA2DS2-VASc score (beyond sex) receive oral anticoagulation? J. Am. Coll. Cardiol. 2015; 65: 635642. DOI: 10.1016/j.jacc.2014.11.046
  14. Nattel S., Harada M. Atrial remodeling and atrial fibrillation: recent advances and translational perspectives. J. Am. Coll. Cardiol. 2014; 63: 2335–45. DOI: 10.1016/j.jacc.2014.02.555
  15. Matanovskaya T.V., Tuev A.V., Orekhova E.N., Sukhanov S.G. Evaluation of the mechanical function of the left atrium in healthy adults. Perm Medical Journal. 2014; 31 (1): 64–71 (in Russ.).
  16. Linz D., Hohl M., Dhein S., Ruf S., Reil J.C., Kabiri M. et al. Cathepsin A mediates susceptibility to atrial tachyarrhythmia and impairment of atrial emptying function in Zucker diabetic fatty rats. Cardiovasc. Res. 2016; 110: 371–80. DOI: 10.1093/cvr/cvw071
  17. Guo Y., Lip G.Y., Apostolakis S. Inflammation in atrial fibrillation. J. Am. Coll. Cardiol. 2012; 60: 2263–70. DOI: 10.1016/j.jacc.2012.04.063
  18. Venteclef N., Guglielmi V., Balse E., Gaborit B., Cotillard A., Atassi F. et al. Human epicardial adipose tissue induces fibrosis of the atrial myocardium through the secretion of adipo-fibrokines. Eur. Heart J. 2015; 36: 795–805a. DOI: 10.1093/eurheartj/eht099
  19. Hatem S.N., Sanders P. Epicardial adipose tissue and atrial fibrillation. Cardiovasc. Res. 2014; 102: 205–13. DOI: 10.1093/cvr/cvu045
  20. Mazurek T., Kiliszek M., Kobylecka M., SkubisrGluhowena J., Kochman J., Fillipiok K. et al. Relation of proinflammatory activity of epicardial adipose tissue to the occurrence of atrial fibrillation. Am. J. Cardiol. 2014; 113 (9): 1505–8. DOI: 10.1016/j.amjcard.2014.02.005
  21. Golukhova E.Z., Gromova O.I., Bulaeva N.I., Arakelyan M.G., Lifanova L.S., Shlyappo M.A. et al. Epicardial fat and atrial fibrillation: the role of profibrogenic mediators. Cardiology. 2018; 58 (7): 59–65 (in Russ.). DOI: 10.18087/cardio.2018.7.10145
  22. Shamloo A.S., Dagres N., Dinov B., Sommer P., Husser-Bollmann D., Bollmann A. et al. Is epicardial fat tissue associated with atrial fibrillation recurrence after ablation? A systematic review and meta-analysis. Int. J. Cardiol. Heart Vasc. 2019; 22: 132–8. DOI: 10.1016/j.ijcha.2019.01.003
  23. Recurrence rates of atrial fibrillation ablation according to body mass Index, a nationwide, registry-based Danish study. In: Atrial fibrillation: new insights. EHRA 2022. Copenhagen; 2022.
  24. Hindricks G., Potpara T., Nikolaos Dagres N., Arbelo E., Bax J.J., Blomström-Lundqvist C. et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of CardioThoracic Surgery (EACTS). Eur. Heart J. 2021; 42: 373–498. DOI: 10.1093/eurheartj/ehaa612
  25. Ma J., Chen Q., Ma S. Left atrial fibrosis in atrial fibrillation: Mechanisms, clinical evaluation and management. J. Cell. Mol. Med. 2021; 25: 2764–75. DOI: 10.1111/jcmm.16350
  26. King J.B., Azadani P.N., Suksaranjit P., Bress A.P., Witt D.M., Han F.T. et al. Left atrial fibrosis and risk of cerebrovascular and cardiovascular events in patients with atrial fibrillation. J. Am. Coll. Cardiol. 2017; 70: 1311–21. DOI: 10.1016/j.jacc.2017.07.758
  27. McGann C., Akoum N., Patel A., Kholmovski E., Revelo P., Domal K., Wilson B. et al. Atrial fibrillation ablation outcome is predicted by left atrial remodeling on MRI. Circ. Arrhythm. Elec. 2014; 7 (1): 23–30. DOI: 10.1161/Circep.113.000689
  28. Cao H., Wang J., Xi L., Røe O.D., Chen Y., Wang D. Dysregulated atrial gene expression of osteoprotegerin/receptor activator of nuclear factor-κB (RANK)/RANK ligand axis in the development and progression of atrial fibrillation. Circ. J. 2011; 75: 2781–8. DOI: 10.1253/circj.cj-11-0795
  29. Zholbaeva A.Z., Tabina A.E., Golukhova E.Z. Molecular mechanisms of atrial fibrillation: in search of an "ideal" marker. Creative Cardiology. 2015; 2: 40–53. DOI: 10.15275/kreatkard.2015.02.04
  30. Dernellis J., Panaretou M. Left atrial function in patients with a high C-reactive protein level and paroxysmal atrial fibrillation. Acta Cardiol. 2006; 61: 507–11 DOI: 10.2143/AC.61.5.2017764
  31. Lip G.Y., Patel J.V., Hughes E., Hart R.G. Highsensitivity C-reactive protein and soluble CD40 ligand as indices of inflammation and platelet activation in 880 patients with nonvalvular atrial fibrillation: Relationship to stroke risk factors, stroke risk stratification schema, and prognosis. Stroke. 2007; 38: 1229–37. DOI: 10.1161/01.STR.0000260090.90508.3e
  32. Pezzo M.P., Tufano A., Franchini M. Role of new potential biomarkers in the risk of thromboembolism in atrial fibrillation. J. Clin. Med. 2022; 11: 915. DOI: 10.3390/jcm11040915 33. Tarnowski D., Poitz D.M., Plichta L., Heidrich F.M., Wiedemann S., Ruf T. et al. Comparison of diverse platelet activation markers as indicators for left atrial thrombus in atrial fibrillation. Platelets. 2018; 29: 41–7. DOI: 10.1080/09537104. 2017.1293805
  33. Hu X.F., Zhan R., Xu S., Wang J., Wu J., Liu X., Chen L. Growth differentiation factor 15 is associated with left atrial/left atrial appendage thrombus in patients with nonvalvular atrial fibrillation. Clin. Cardiol. 2018; 41: 34–8. DOI: 10.1002/clc.22844
  34. Duygu H., Barisik V., Kurt H., Turk U., Ercan E., Kose S. Prognostic value of plasma soluble CD40 ligand in patients with chronic non-valvular atrial fibrillation. Europace. 2008; 10: 210–4. DOI: 10.1093/europace/eum284
  35. Yuan S., Lin A., He Q.Q., Burgess S., Larsson S.C. Circulating interleukins in relation to coronary artery disease, atrial fibrillation and ischemic stroke and its subtypes: A two-sample Mendelian randomization study. Int. J. Cardiol. 2020; 313: 99–104. DOI: 10.1016/j.ijcard.2020.03.053
  36. Wann L.S., Curtis A.B., January C.T., Ellenbogen K.A., Lowe J.E., Estes N.A. 3rd et al. 2011 ACCF/AHA/HRS Focused Update on the Management of Patients with Atrial Fibrillation (Updating the 2006 Guideline). A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J. Am. Coll. Cardiol. 2011; 57 (2): 223–42. DOI: 10.1161/j.jacc.2010.10.001
  37. Shen J., Lall S., Zheng V., Buckley P., Damiano R.J.Jr, Schuessler R.B. The persistent problem of new-onset postoperative atrial fibrillation: a single-institution experience over two decades. J. Thorac. Cardiovasc. Surg. 2011; 141: 559–70. DOI: 10.1016/j.jtcvs.2010.03.011
  38. Greenberg J.W., Lancaster T.S., Schuessler R.B., Melby S.J. Postoperative atrial fibrillation following cardiac surgery: a persistent complication. Eur. J. Cardiothorac. Surg. 2017; 52 (Issue 4): 665–72. DOI: 10.1093/ejcts/ezx039
  39. Melby S.J., George J.F., Picone D.J., Wallace J.P., Davies J.E., George D.J., Kirklin J.K. A time-related parametric risk factor analysis for postoperative atrial fibrillation after heart surgery. J. Thorac. Cardiovasc. Surg. 2015; 149: 886–92. DOI: 10.1016/j.jtcvs.2014.11.032
  40. Soucier R.J., Mirza S., Abordo M.G., Berns E., Dalamagas H.C., Hanna A., Silverman D.I. Predictors of conversion of atrial fibrillation after cardiac operation in the absence of class I or III antiarrhythmic medications. Ann. Thorac. Surg. 2001; 72 (3): 694–7; disc. 697–8. DOI: 10.1016/s0003-4975(01)02817-x
  41. Keshava H.B., Boffa D.J. Cardiovascular complications following thoracic surgery. Thorac. Surg. Clin. 2015; 25 (4): 371–92. DOI: 10.1016/j.thorsurg.2015.07.001 43. Villareal R.P., Hariharan R., Liu B.C., Kar B., Lee V.V., Elayda M. et al. Postoperative atrial fibrillation and mortality after coronary artery bypass surgery. J. Am. Coll. Cardiol. 2004; 43: 742–8. DOI: 10.1016/j.jacc.2003.11.023
  42. Mitchell L.B.; CCS Atrial Fibrillation Guidelines Committee. Canadian Cardiovascular Society atrial fibrillation guidelines 2010: prevention and treatment of atrial fibrillation following cardiac surgery. Can. J. Cardiol. 2011; 27 (1): 91–7. DOI: 10.1016/j.cjca.2010.11.005
  43. Greenberg J.W., Lancaster T.S., Schuessler R.B., Melby S.J. Postoperative atrial fibrillation following cardiac surgery: a persistent complication. Eur. J. Cardiothorac. Surg. 2017; 52 (Issue 4): 665–72. DOI: 10.1093/ejcts/ezx039
  44. Xiong T., Pu L., Ma Y.F., Zhu Y.-L., Li H., Cui X. et al. Posterior pericardiotomy to prevent newonset atrial fibrillation after coronary artery bypass grafting: a systematic review and meta-analysis of 10 randomized controlled trials. J. Cardiothorac. Surg. 2021; 16: 233. DOI: 10.1186/s13019-021-01611-x
  45. Yadava M., Hughey A.B. Postoperative atrial fibrillation: incidence, mechanisms, and clinical correlates. Heart Fail. Clin. 2016; 12 (2): 299–308. DOI: 10.1016/j.hfc.2015.08.023
  46. Alqahtani A.A.R. Atrial fibrillation post cardiac surgery trends toward management. Offic. J. Gulf Heart Assoc. 2010; 11 (2): 57–63. DOI: 10.4103/1995-705X.73212
  47. Hashemzadeh K., Dehdilani M. Postoperative atrial fibrillation following open cardiac surgery: predisposing factors and complications. J. Cardiovasc. Thorac. Res. 2013; 5 (3): 101–7. DOI: 10.5681/jcvtr.2013.022
  48. Guerrero A.F., Camacho J.M., Sandoval N.F., Umaña J.P., Obando C.E., Carreño M. Factors associated with postoperative renal failure in myocardial revascularization surgery. Colomb. J. Cardiol. 2015; 23 (3): 230–6. DOI: 10.1016/j.rccar.2015.09.006

About Authors

  • Natal’ya Yu. Sokolova, Dr. Med. Sci., Professor of Chair; ORCID
  • Ekaterina A. Savel’eva, Cardiologist; ORCID
  • Dmitriy S. Popov, Cardiologist; ORCID
  • Kseniya A. Martynova, Postgraduate; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery