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Published on: March 26, 2018
Early and Late Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting and Surgical Aortic Valve
Andrzej Kułach1, Tomasz Skowerski1, Magdalena Piekarska2
1Department of Cardiology, School of Health Sciences, Medical University of Silesia, 40-635 Katowice, Poland.
Insights
Postoperative atrial fibrillation (POAF) is common after heart surgery and often occurs more than 10 days post-discharge. Extended monitoring to 30 days significantly improves detection rates for this late POAF.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Postoperative atrial fibrillation (POAF) is a frequent complication following cardiac surgery, impacting patient outcomes.
- Current strategies for post-discharge electrocardiogram (ECG) surveillance for POAF are not standardized.
- Understanding the incidence and timing of POAF is crucial for optimizing patient care pathways.
Purpose of the Study:
- To evaluate the incidence of POAF after isolated coronary artery bypass grafting (CABG) and surgical aortic valve replacement (SAVR).
- To assess the effectiveness of a dual-modality ambulatory ECG monitoring strategy for detecting POAF post-discharge.
- To determine the optimal duration for post-discharge surveillance of POAF.
Main Methods:
- An exploratory, single-center study enrolled patients undergoing elective isolated CABG or SAVR without prior atrial fibrillation (AF).
- Patients utilized a dual-modality monitoring approach: a 10-day continuous Holter monitor and a 30-day patient-activated single-lead recorder.
- POAF was categorized as early (in-hospital) or late (post-discharge) based on detection timing.
Main Results:
- Late POAF was detected in 38.2% of patients, with a significant proportion occurring after 10 days of monitoring.
- The 30-day patient-activated recorder captured 90% of late POAF cases, highlighting its utility.
- Female sex was independently associated with late POAF; early POAF predicted subsequent late POAF.
Conclusions:
- Late POAF is a common occurrence after CABG and SAVR, frequently manifesting beyond the initial 10-day postoperative period.
- Extending ambulatory ECG surveillance to 30 days, or employing a hybrid approach, substantially enhances the detection of late POAF.
- These findings support the integration of extended post-discharge monitoring into routine care for patients undergoing cardiac surgery.
Abstract:
Background: Postoperative atrial fibrillation (POAF) after cardiac surgery is common and clinically relevant, yet optimal postdischarge ECG surveillance remains undefined. We assessed the incidence of POAF after isolated coronary artery bypass grafting (CABG) and surgical aortic valve replacement (SAVR) using a dual-modality ambulatory strategy. Methods: In an exploratory, single-center study, consecutive adults without pre-operative AF undergoing elective isolated CABG or SAVR received dual-modality monitoring after discharge: continuous patch-Holter for ~10 days and a patient-activated single-lead recorder for up to 30 days. Early POAF was AF/AFl during index hospitalization; late POAF was first AF/AFL detected postdischarge by either modality. Results: Fifty-five patients were enrolled (CABG 30 [54.5%], SAVR 25 [45.5%]; mean age 64.6 ± 9.8 years; 38.2% women). Early POAF occurred in 10/49 (20.4%); late POAF was detected in 21/55 (38.2%). By modality, late AF was identified on the 10-day Holter in 11/51 (21.6%) and on the 30-day recorder in 19/51 (37.3%). Cumulative detection reached 20.0% by day 7, 30.9% by day 10, and 38.2% thereafter, demonstrating that a substantive proportion of late POAF occurred after day 10, and 19/21 (90%) were captured by event monitoring. Female sex was independently associated with late POAF (OR 3.70, 95% CI 1.17-11.72); longer aortic cross-clamp time was related to late POAF in the SAVR subset, while larger LA size was related to POAF incidence in the CABG group. Early (in-hospital) POAF was associated with subsequent late POAF (p = 0.025). The difference in late POAF frequency between CABG and SAVR (33.3% vs. 44.0%; p = 0.42) was not significant. Conclusions: Among patients without prior AF undergoing CABG or SAVR, late POAF is frequent and often manifests beyond 10 days after discharge. Extending ambulatory surveillance to 30 days-or adopting a 10-day continuous plus patient-activated to day 30 hybrid-materially improves case finding and should be considered in routine postoperative pathways.
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