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Published on: February 26, 2013
Prognosis of transient new-onset atrial fibrillation during vascular surgery
T A Winkel1, O Schouten, S E Hoeks
1Department of Vascular Surgery, Erasmus MC, 's Gravendijkwal 230, Rotterdam, The Netherlands.
Insights
New-onset atrial fibrillation (AF) during vascular surgery increases the risk of cardiovascular events. Continuous ECG monitoring identified this association, highlighting the need for vigilance in surgical patients.
Area of Science:
- Cardiology
- Vascular Surgery
- Electrophysiology
Background:
- Chronic atrial fibrillation (AF) is linked to cardiovascular events.
- The prognosis of new-onset AF during vascular surgery remains unclear.
Purpose of the Study:
- To investigate the prognosis of new-onset AF in vascular surgery patients.
- Utilize continuous electrocardiographic monitoring (continuous-ECG) for detection.
Main Methods:
- 317 patients undergoing major vascular surgery in sinus rhythm were monitored.
- Continuous-ECG for 72 hours and standard ECGs identified new-onset AF.
- Composite endpoint: cardiac death, MI, unstable angina, stroke within 30 days and late follow-up.
Main Results:
- New-onset AF occurred in 4.7% of patients.
- New-onset AF was associated with significantly increased perioperative (HR 6.0) and late (HR 4.2) cardiovascular events.
- Most patients with new-onset AF spontaneously reverted to sinus rhythm.
Conclusions:
- New-onset AF during vascular surgery is a significant predictor of adverse cardiovascular outcomes.
- This finding underscores the importance of monitoring for AF in this patient population.
Background:
Chronic atrial fibrillation (AF) in a non-surgical setting is associated with cardiovascular events. However, the prognosis of transient new-onset AF during vascular surgery is unknown.
Objective:
The purpose of this study is to investigate the prognosis of new-onset AF during vascular surgery using continuous electrocardiographic monitoring (continuous-ECG).
Methods:
In this study, 317 patients, all in sinus rhythm, scheduled for major vascular surgery were screened for cardiac risk factors. Continuous-ECG recordings for 72h and standard ECG on days 3, 7 and 30 were used to identify new-onset AF. Cardiac troponin T (cTnT) was measured routinely after surgery. Study endpoint was a composite of cardiac death, myocardial infarction, unstable angina and stroke (cardiovascular events) at 30 days after surgery and during late follow-up. Median follow-up was 12 (interquartile range 2-28) months.
Results:
New-onset AF was noted in 15 (4.7%) patients. All but three patients returned spontaneously to sinus rhythm. The composite endpoint of cardiovascular events within 30 days and during late follow-up occurred in 34 (11%) and 62 (20%) patients, respectively. Multivariate regression analysis showed that new-onset AF was associated with perioperative (hazard ratio (HR) 6.0; 95% CI: 2.4-15) and late cardiovascular events (HR 4.2, 95% CI: 2.1-8.8).
Conclusion:
New-onset AF during vascular surgery is associated with an increased incidence of 30-day and late cardiovascular events.
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