This systematic review included 31 studies involving 4,983 adults undergoing cardiac surgery and examined oxidative stress biomarkers associated with postoperative atrial fibrillation (POAF). Pooled POAF incidence was 30.4% (95% CI 27.4–33.5). Atrial oxidative stress biomarkers were higher among patients developing POAF (Hedges g 0.89, 95% CI 0.45–1.32), whereas corresponding blood measurements showed no statistically significant difference (g 0.13, 95% CI −0.04–0.30). The between-compartment difference was 0.76 (p=0.005), highlighting the importance of sampling site. Most included studies were at high risk of bias, and clinical utility remains unvalidated.
Oxidative stress biomarkers show sampling-site-dependent associations with POAF, with stronger signals in atrial tissue than blood. These findings do not establish a clinically useful prediction strategy.
Study limitation: Most studies had high risk of bias, and heterogeneous sampling sites and timing limit interpretation and clinical applicability.
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