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Pre- and postoperative atrial fibrillation in CABG patients have similar prognostic impact
Espen Fengsrud1, Anders Englund2, Anders Ahlsson1
1a Department of Cardiology and Cardiothoracic Surgery , School of Health and Medical Sciences, Örebro University Hospital , Örebro , Sweden.
Insights
Patients with atrial fibrillation (AF) before or after aortocoronary bypass surgery face higher long-term mortality risks. This includes increased chances of death from stroke, heart failure, and sudden cardiac arrest.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Atrial fibrillation (AF) is a common arrhythmia.
- Aortocoronary bypass graft (ACBG) surgery is a major cardiac procedure.
- The long-term impact of pre- and postoperative AF on ACBG patients requires further investigation.
Purpose of the Study:
- To investigate the prevalence of pre- and postoperative atrial fibrillation in ACBG patients.
- To assess the long-term effects of atrial fibrillation on mortality and causes of death in this cohort.
- To determine if AF is an independent risk factor for late mortality after ACBG.
Main Methods:
- A cohort of 615 patients undergoing ACBG between 1999-2000 was studied.
- Preoperative AF was present in 7% of patients; postoperative AF occurred in 27%.
- Median follow-up was 15 years, recording patient symptoms, medication, and cause of death.
Main Results:
- Patients with pre- or postoperative AF had significantly higher rates of death from cerebral ischemia, heart failure, and sudden death compared to those in sinus rhythm.
- Preoperative AF was associated with a 47% increased risk of late mortality (HR 1.47).
- Postoperative AF was associated with a 28% increased risk of late mortality (HR 1.28).
Conclusions:
- Pre- or postoperative atrial fibrillation in ACBG patients is linked to increased long-term mortality.
- These patients face a higher risk of cerebral ischemic and cardiovascular death.
- Atrial fibrillation status should be considered in the long-term management of ACBG patients.
Objectives:
To study pre- and postoperative atrial fibrillation and its long-term effects in a cohort of aortocoronary bypass surgery patients.
Design:
Altogether 615 patients undergoing aortocoronary bypass graft surgery in 1999-2000 were studied. Forty-four (7%) had preoperative atrial fibrillation. Postoperative atrial fibrillation occurred in 165/615 patients (27%) while 406/615 patients (66%) had no atrial fibrillation. After a median follow-up of 15 years, symptoms and medication in survivors were recorded, and cause of death in the deceased was obtained.
Results:
Death due to cerebral ischaemia was most common in the pre- and postoperative atrial fibrillation groups (7% and 5%, respectively, v. 2% among those without atrial fibrillation, p = .038), as were death due to heart failure (18% and 14%, v. 7%, p = .007) and sudden death (9% and 5%, v. 2%, p = .029). The presence of pre- or postoperative atrial fibrillation was an independent risk factor for late mortality (hazard ratios 1.47 (1.02-2.12) and 1.28 (1.01-1.63), respectively).
Conclusions:
Patients with pre- or postoperative atrial fibrillation undergoing aortocoronary bypass surgery have increased long-term mortality and risk of cerebral ischemic and cardiovascular death compared with patients in sinus rhythm.
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