Abstract
Background: Post-operative (POP) atrial fibrillation (AF) is frequent in patients who undergo cardiac surgery. However, its prognostic impact in the long term remains unclear. Methods: We followed 1386 patients who underwent cardiac surgery for an average of 10 ± 3 years. According to clinical history of AF before and after surgery, four subgroups were identified: (1) patients with no history of AF and without episodes of AF during the first 30 days after surgery (control or Group 1, n = 726), (2) patients with no history of AF before surgery in whom new-onset POP AF was detected during the first 30 days after surgery (new-onset POP AF or Group 2, n = 452), (3) patients with a history of paroxysmal/persistent AF before cardiac surgery (Group 3, n = 125, including 87 POP AF patients and 38 who did not develop POP AF), and (4) patients with permanent AF at the time of cardiac surgery (Group 4, n = 83). All-cause mortality was the primary outcome of the study. We tested the associations of potential determinants with all-cause mortality using univariable and multivariable statistical analyses. Results: Overall, 473 patients (34%) died during follow-up. After adjustment for multiple confounders, new-onset POP AF (hazard ratio (HR) = 1.31, 95% confidence interval (CI): 0.90–1.89; p = 0.1609), history of paroxysmal/persistent AF before cardiac surgery (HR = 1.33, 95% CI: 0.71–2.49; p = 0.3736), and permanent AF (Group 4) (HR = 1.55, 95% CI 0.82–2.95; p = 0.1803) were not associated with a significantly increased risk of mortality when compared with Group 1 (patients with no history of AF and without episodes of AF during the first 30 days after surgery). In new-onset POP AF patients, oral anticoagulation was not associated with mortality (HR = 1.13, 95% CI: 0.83–1.54; p = 0.4299). Conclusions: In this cohort of patients who underwent different types of heart surgery, POP AF was not associated with an increased risk of mortality. In this setting, the role of long-term anticoagulation remains unclear.
Highlights
Post-operative atrial fibrillation (POP AF) is the most common cardiac arrhythmia occurring after cardiac surgery, ranging from 15% to 36% of post-surgical cases depending on the type of surgery and the prevalence of cardiovascular and non-cardiovascular comorbidities in different patient cohorts [1,2]
Few data are available for other different surgical settings, such as valvular heart surgery (VHS), and for POP AF episodes occurring in patients with known AF history before cardiac surgery
We evaluated the effect of prognostic factors on mortality by the Cox proportional-hazards model, and the derived hazard ratios (HRs) were expressed with their corresponding two-sided 95% confidence intervals (CI)
Summary
Post-operative atrial fibrillation (POP AF) is the most common cardiac arrhythmia occurring after cardiac surgery, ranging from 15% to 36% of post-surgical cases depending on the type of surgery and the prevalence of cardiovascular and non-cardiovascular comorbidities in different patient cohorts [1,2]. Recent studies in the field have mainly investigated the long-term outcome associated with POP AF occurring in patients naïve to AF history (newonset POP AF) and after coronary artery bypass surgery (CABG) only [1,2]. Few data are available for other different surgical settings, such as valvular heart surgery (VHS), and for POP AF episodes occurring in patients with known AF history before cardiac surgery. Even more interestingly, it seems that POP AF underpins a kaleidoscope of different pathophysiological and clinical substrates in these patients which might yield a variable long-term prognosis in specific POP AF population subsets [4].
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