Abstract 9968: Classification and Treatment of Post-Operative Atrial Arrhythmias in Pulmonary Thromboendarterectomy Surgery

Abstract

Background: Atrial arrhythmias (AA) are common after cardiac surgeries including pulmonary thromboendarterectomy (PTE) surgery. However, the arrhythmia classification, treatment and impact of these AA after PTE surgery is unclear. Hypothesis: We hypothesized that most AA after PTE are paroxysmal and have a significant impact on post-operative outcomes. Methods: We reviewed the charts of 883 consecutive patients who were referred to University of California San Diego for PTE. Demographics, lab results and imaging were extracted from chart review. Predictors and outcomes were analyzed using a multivariate backward logistic regression model or independent samples t test respectively. Results: A total of 158 patients (18%) of patients developed an atrial arrhythmia. Paroxysmal atrial fibrillation (AF) was most common (72%, n=113). Persistent AF occurred in 8% of patients (n=12) and atrial flutter occurred in 21% (n=33) after PTE. The average days to onset of AA was 5.6 +/-4.4 days. Strongest predictors of AA (shown in attached figure) were chronic obstructive pulmonary disease (OR 2.8, p=<0.01) and epicardial pacing requirement (OR 4.6, p=<0.01). Patients who developed an AA had significantly prolonged post-operative length of stays (LOS) (14.7 days vs 11.9 days, p=<0.01) compared to those who did not. Amiodarone was given in 73% (n=115) of patients and cardioversion was performed in 15% (n=23) of AA patients. Conclusions: AA are common after PTE surgery. Paroxysmal atrial fibrillation was seen most commonly. Patients who had COPD or required epicardial pacing were at highest risk of developing an AA. AA have a significantly prolonged post-operative LOS. The majority of patients received antiarrhythmic therapy with amiodarone (73%) and a minority underwent cardioversion (15%)