Clinical Course of Postoperative Atrial Fibrillation After Cardiac Surgery and Long-Term Outcome – DocWire News

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Ann Thorac Surg. 2022 Apr 14:S0003-4975(22)00513-6. doi: 10.1016/j.athoracsur.2022.03.062. Online ahead of print.

ABSTRACT

BACKGROUND: New-onset postoperative atrial fibrillation (POAF) after cardiac surgery is associated with worse short- and long-term outcome. Although the clinical presentation of POAF varies substantially, almost all studies model it with a dichotomous yes/no variable. We explored potential associations between the clinical course of POAF and long-term outcome.

METHODS: This retrospective observational single-center study included 6435 CABG and/or valve patients between 2010 and 2018. POAF patients were grouped into 1) spontaneous/pharmacological conversion to sinus rhythm, 2) sinus rhythm after electrical cardioversion, and 3) sustained atrial fibrillation (AF) at discharge. Multivariable Cox regression models adjusted for age, sex, type of surgery, co-morbidities, and early-initiated oral anticoagulation were used to study associations between the clinical course of POAF and long-term risk for mortality, ischemic stroke, thromboembolic events, heart failure hospitalization, and major bleeding. Median follow-up time was 3.8 years (range: 0-8.3 years).

RESULTS: POAF occurred in 2172 (33.8%) of the patients, 94.9% of whom converted to sinus rhythm before discharge. Of these, 73.6% converted spontaneously or with pharmacological treatment, and 26.4% after electrical cardioversion. Both sustained AF and electrical cardioversion were independently associated with an increased long-term risk for heart failure (adjusted hazard ratio for sustained AF at discharge: 2.55, 95%CI: 1.65-3.93, p<0.001; for electrical cardioversion: 1.28, 95%CI: 1.00-1.65, p=0.047), but not with increased long-term risk for death, thromboembolic complications, or bleedings.

CONCLUSIONS: A more complicated POAF course is associated with increased long-term risk for heart failure hospitalization, but not for all-cause mortality or thromboembolic complications.

PMID:35430224 | DOI:10.1016/j.athoracsur.2022.03.062

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Clinical Course of Postoperative Atrial Fibrillation After Cardiac Surgery and Long-Term Outcome - DocWire News