Abstract
BackgroundWe studied potential risk factors for postoperative atrial fibrillation (POAF) in a large cohort of patients who underwent open-heart surgery, evaluating short- and long-term outcome, and we developed a risk-assessment model of POAF.MethodsA retrospective study of 744 patients without prior history of AF who underwent CABG (n = 513), OPCAB (n = 207), and/or AVR (n = 156) at Landspitali Hospital in 2002–2006. Logistic regression analysis was used to study risk factors for POAF, comparing patients with and without POAF.ResultsThe rate of POAF was 44%, and was higher following AVR (74%) than after CABG (44%) or OPCAB (35%). In general, patients with POAF were significantly older, were more often female, were less likely to be smokers, had a lower EF, and had a higher EuroSCORE. The use of antiarrythmics was similar in the groups but patients who experienced POAF were less likely to be taking statins. POAF patients also had longer hospital stay, higher rates of complications, and operative mortality (5% vs. 0.7%). In multivariate analysis, AVR (OR 4.4), a preoperative history of cardiac failure (OR 1.8), higher EuroSCORE (OR 1.1), and advanced age (OR 1.1) were independent prognostic factors for POAF. Overall five-year survival was 83% and 93% for patients with and without POAF (p <0.001).ConclusionPOAF was detected in 44% of patients, which is high compared to other studies. In the future, our assessment score will hopefully be of use in identifying patients at high risk of POAF and lower complications related to POAF.
Highlights
We studied potential risk factors for postoperative atrial fibrillation (POAF) in a large cohort of patients who underwent open-heart surgery, evaluating short- and long-term outcome, and we developed a risk-assessment model of POAF
Incidence of POAF was significantly lower in patients who underwent off-pump coronary artery bypass grafting (OPCAB) than in those who underwent conventional coronary artery bypass grafting (CABG) (35% vs. 46%, p = 0.01)
Fewer coronary vessels were affected in the POAF group, but their ejection fraction (EF) was lower and their EuroSCORE was higher
Summary
We studied potential risk factors for postoperative atrial fibrillation (POAF) in a large cohort of patients who underwent open-heart surgery, evaluating short- and long-term outcome, and we developed a risk-assessment model of POAF. Reported rates of POAF after surgical revascularization and atrial valve replacement (AVR) range widely, from 3% to 90%, but with most of them in the 20–40% range [9,10]. This variation is related to different patient populations, methods and duration of arrhythmia surveillance, and use of medication for prophylactic purposes. Up to 80% of patients convert to sinus rhythm (SR) within 24 h, and six weeks after initial diagnosis 98% of patients have converted to SR [11]
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