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Clinical Significance of Postoperative Atrial Fibrillation in Hypertrophic Cardiomyopathy Patients Undergoing Septal

Roxana Bataiosu1, Sara Hoss1, Fernando L Scolari1

  • 1Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.

The Canadian Journal of Cardiology
|June 24, 2023
PubMed

Insights

Postoperative atrial fibrillation (POAF) is common after hypertrophic cardiomyopathy (HCM) surgery and predicts future atrial fibrillation (AF). However, cardioembolic events are rare, suggesting long-term anticoagulation may not be routinely needed for POAF patients.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Electrophysiology

Background:

  • Hypertrophic cardiomyopathy (HCM) management requires understanding postoperative complications.
  • Postoperative atrial fibrillation (POAF) is a frequent concern after surgical myectomy in HCM patients.
  • The long-term implications of POAF, specifically AF incidence and cardioembolic events, are not well-defined.

Purpose of the Study:

  • To investigate the association between POAF and subsequent atrial fibrillation (AF) or cardioembolic events in HCM patients post-myectomy.
  • To identify predictors of POAF in this patient population.
  • To inform optimal anticoagulation strategies following surgical myectomy for HCM.

Main Methods:

  • Retrospective analysis of 1176 HCM patients undergoing surgical myectomy at two North American centers (2002-2020).
  • Exclusion of patients with preoperative AF; POAF defined as AF within 30 days post-surgery.
  • Multivariable analysis to identify predictors of POAF and AF during long-term follow-up (mean 4.3 years).

Main Results:

  • POAF occurred in 31.9% of patients; predictors included older age, larger premyectomy left atrial diameter (LAD), and smoking.
  • POAF was a significant predictor of AF during follow-up (HR 4.20).
  • Cardioembolic events were uncommon (1.6%) and not significantly associated with POAF, with only 3 POAF patients experiencing events >4 years post-surgery.

Conclusions:

  • POAF is a common and significant predictor of future AF in HCM patients after myectomy.
  • Long-term cardioembolic risk following myectomy appears low, even in the presence of POAF.
  • Routine long-term anticoagulation for all HCM patients with POAF may not be necessary beyond the initial postoperative period.
Abstract

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