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Published on: February 26, 2013
High incidence of atrial fibrillation after coronary surgery
Emma Thorén1, Laila Hellgren2, Elisabeth Ståhle2
1Department of Cardiothoracic Surgery, Uppsala University Hospital, Uppsala, Sweden emma.thoren@akademiska.se.
Insights
A significant number of patients experience post-discharge atrial fibrillation (AF) after coronary artery bypass surgery (CABG). Those with prior postoperative atrial fibrillation (POAF) face a substantially higher risk of developing AF within 30 days post-discharge.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Postoperative atrial fibrillation (POAF) is common after coronary artery bypass surgery (CABG), affecting one-third of patients.
- Short-term heart rhythm monitoring after hospital discharge has been inconsistent, leading to varied findings on post-discharge atrial fibrillation (AF).
Purpose of the Study:
- To determine the incidence of atrial fibrillation (AF) in the 30 days following hospital discharge in patients who underwent coronary artery bypass surgery (CABG).
Main Methods:
- A cohort of 67 patients undergoing CABG was studied, including 19 with prior POAF and 48 without.
- Patients performed daily electrocardiogram (ECG) recordings and symptom-triggered registrations for 30 days post-discharge.
- The incidence of post-discharge AF was compared between patients with and without prior POAF.
Main Results:
- Thirty percent (20 of 67) of patients developed post-discharge AF, with 35% of these cases being asymptomatic.
- Patients with prior POAF had a significantly higher incidence of post-discharge AF (58%) compared to those without (19%), with six times the odds.
- Episodes of post-discharge AF occurred earlier in patients with prior POAF (mean Day 3) than in those without (mean Day 10).
Conclusions:
- A substantial proportion of patients experience both symptomatic and asymptomatic AF within 30 days after CABG discharge.
- Patients with a history of POAF exhibit a markedly increased risk of developing post-discharge AF, with over half experiencing it.
Objectives:
Postoperative atrial fibrillation (POAF) affects a third of all patients after coronary artery bypass surgery (CABG), but short-term follow-up of heart rhythm after discharge has been sporadic and shown varied results. The aim of this study was to examine the incidence of post-discharge atrial fibrillation (AF) for 30 days following hospital discharge after CABG.
Methods:
A total of 67 patients, 19 (28%) with POAF during the initial hospitalization and 48 (72%) without POAF were included. Patients recorded intermittent electrocardiogram registrations three times daily, and additionally in case of arrhythmia symptoms. Presence of post-discharge AF was compared between the groups. All patients were in sinus rhythm at discharge.
Results:
Twenty of 67 patients (30%) were diagnosed with post-discharge AF. Overall, 35% of them were entirely asymptomatic. POAF patients had a higher incidence of post-discharge AF (11 of 19, 58%) than non-POAF patients (9 of 48, 19%), with six times the odds of developing post-discharge AF compared with non-POAF patients [odds ratio (OR) 6.0; 95% CI 1.9-19, P = 0.002]. Patients with POAF registered episodes of post-discharge AF earlier during the follow-up period (mean Day 3 after discharge, range 1-9 days) than non-POAF patients (Day 10, range 7-14 days, P < 0.001).
Conclusions:
A high incidence of both symptomatic and asymptomatic AF was recorded during 30 days following hospital discharge after CABG. The incidence was highest among patients with POAF, of whom more than half experienced post-discharge AF.
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