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Sex differences in postoperative atrial fibrillation and posterior left pericardiotomy: Subanalysis of the Posterior
Alexander C Gregg1, Lisa Q Rong2, Sigrid Sandner3
1Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.
Background:
This post hoc analysis of the Posterior Left Pericardiotomy for the Prevention of AtriaL Fibrillation After Cardiac Surgery (PALACS) trial examined the association between sex and postoperative atrial fibrillation characteristics after cardiac surgery.
Methods:
In PALACS, patients undergoing cardiac surgery were randomized to posterior left pericardiotomy or no intervention. This analysis stratified participants by sex, evaluating differences in postoperative atrial fibrillation incidence, duration, burden, postoperative in-hospital length of stay, and pericardial effusions.
Result:
All 420 PALACS patients were included, consisting of 24% (102/420) female patients. Postoperative atrial fibrillation occurred in 22% (22/102) of female patients and 25% (81/318) of male patients (P = .51). Female sex was associated with a lower postoperative atrial fibrillation risk (adjusted odds ratio, 0.47, 95% CI, 0.24-0.87, P = .02). Posterior left pericardiotomy reduced the risk of postoperative atrial fibrillation (adjusted odds ratio, 0.46 95% CI, 0.28-0.76, P = .003), without difference by sex (pinteraction = .59). No sex differences were observed in postoperative atrial fibrillation duration or burden. Female patients had longer postoperative in-hospital length of stay (median 7 [interquartile range, 5-8] days vs 6 [interquartile range, 5-7] days, P = .005); however, sex was not independently associated with hospitalization length (adjusted β 1079, 95% CI, -448 to 2605, P = .17). Pericardial effusion incidence and size did not differ by sex. Moderate (>10 mm) posterolateral pericardial effusion was associated with higher postoperative atrial fibrillation incidence (adjusted odds ratio, 2.98, 95% CI, 1.07-8.16, P = .03), without sex difference (pinteraction = .61).
Conclusions:
In PALACS, female patients had a lower adjusted risk of postoperative atrial fibrillation; however, the clinical course of postoperative atrial fibrillation was similar between sexes. Posterior left pericardiotomy reduced postoperative atrial fibrillation incidence without evidence of sex-specific heterogeneity.
