Timing Of Atrial Fibrillation Research Articles

The Incidence and Natural Progression ofNew-Onset Postoperative AtrialFibrillation.

This study aimed to characterize the natural progression and recurrence of new-onset postoperative atrial fibrillation (POAF) during an intermediate-term follow-up post cardiac surgery by using continuous event monitoring. New-onset POAF is a common complication after cardiac surgery and is associated with an increased risk for stroke and all-cause mortality. Long-term data on new POAF recurrence and anticoagulation remain sparse. This is a single-center, prospective observational study evaluating 42 patients undergoing cardiac surgery and diagnosed during indexed admission with new-onset, transient, POAF between May 2015 and December 2019. Before discharge, all patients received implantable loop recorders for continuous monitoring. Study outcomes were the presence and timing of atrial fibrillation (AF) recurrence (first, second, and more than 2 AF recurrences), all-cause mortality, and cerebrovascular accidents. A "per-month interval" analysis of proportion of patients with any AF recurrence was assessed and reported per period of follow-up time. Kaplan-Meier analysis was used to calculate the time to first AF recurrence and report the first AF recurrence rates. Forty-two patients (mean age 67.6 ± 9.6 years, 74% male, mean CHADS2-VASc 3.5 ± 1.5) were evaluated during a mean follow-up of 1.7 ± 1.2 years. AF recurrence after discharge occurred in 30 patients (71%) and of those, 59% had AF episodes equal to or longer than 5minutes (median AF duration at 1month was 32minutes [interquartile range 5.5-106], whereas median AF duration beyond 1month was 15minutes [interquartile range 6.3-49]). Twenty-four (80%) of the 30 patients had their first AF recurrence within the first month. During months 1 to 12 follow-up, 76% of patients had any AF recurrences (10% had their first AF recurrence, 43% had their second AF recurrence, and 23% had more than 2 AF recurrences). Beyond 1 year of follow-up, 30% of patients had any AF recurrences (10% had their first AF recurrence, 7% had their second AF recurrence, and 13% had more than 2 AF recurrences). Using Kaplan-Meier analysis, the median time to first AF recurrence was 0.83months (95% CI: 0.37 to 6) and the detection of first AF recurrence rate at 1, 3, 6, 12, 18, and 24months was 57.1%, 59.5%, 64.3%, 64.3%, 67.3%, and 73.2%, respectively. During follow-up, there was 1 death ([-] AF recurrence) and 2 cerebrovascular accidents ([+] AF recurrence). In this study of continuous monitoring with implantable loop recorders, the recurrence of AF in patients who develop transient POAF is common in the first month postoperatively. Of the patients who developed postoperative AF, 76% had any recurrence in months 1 to 12, and 30% had any recurrence beyond 1-year follow-up. Current guidelines recommend anticoagulation for POAF for 30days. The results of this study warrant further investigation into continued monitoring and longer-term anticoagulation in this population within the context of our findings that AF duration was <30minutes beyond 1month.

Prognostic significance of incident atrial fibrillation following STEMI depends on the timing of atrial fibrillation.

Atrial fibrillation (AF) is associated with short-term mortality after ST-elevation myocardial infarction (STEMI), but there is limited data on the temporal association between AF and mortality after STEMI. A total of 830 patients were included (age: 62 ± 12 years, 76 % male). Patients with new-onset AF < 30 days after STEMI were divided among three subgroups: AF on the day of admission, AF 24–72 h and AF > 72 h after admission. Thirty-day mortality was assessed by telephone and via the municipal population registry. Twenty patients died < 30 days after admission. In 41 patients, AF was detected on the day of admission, in 14 patients 24–72 h after admission and in 18 patients > 72 h after admission. Mortality was higher in patients with AF on the day of admission (7.3 vs 2.2 %, p = 0.036) and 24–72 h after admission (14.3 vs 1.4 %, p < 0.001), but not in patients with AF > 72 h after admission (0 vs 1.1 %, p > 0.999). Age (odds ratio (OR) 1.123, p < 0.001), Killip class (adjusted OR 8.341, p < 0.001), AF on the day of admission (OR 3.585, p = 0.049) and 24–72 h after admission (OR 11.515, p = 0.003) were, amongst other variables, associated with an increased 30-day mortality. In conclusion, only new-onset incident AF during the first 72 h after admission was associated with 30-day mortality in STEMI patients.Electronic supplementary materialThe online version of this article (doi:10.1007/s12471-015-0709-2) contains supplementary material, which is available to authorized users.

CONVERSION TO SINUS RHYTHM WITH IBUTILIDE DURING ATRIAL FIBRILLATION ABLATION IS NOT ASSOCIATED WITH LONG TERM SINUS RHYTHM MAINTENANCE

Identifying patients at higher risk of AF recurrence after successful ablation would help with selection of patients for more frequent post-ablation surveillance, more accurate individualized patient prognosis and decision regarding future management options such as anti-coagulation therapy. In patients who remain in AF after ablation, ibutilide is frequently used for restoration of sinus rhythm. In cases of failure to achieve SR with ibutilide, DCCV is used. We hypothesized that termination of AF with ibutilide defines a group of patients with a better long-term outcome. This is a retrospective observational study of 92 AF ablation procedures with drug-refractory symptomatic AF who were followed for a year by routine clinic visits in 3-6 month intervals or earlier in symptomatic patients. Recurrence and timing of atrial fibrillation during follow-up period was documented and compared among 3 groups of patients according to their response to ablation and administration of ibutilide at the time of ablation: spontaneous conversion to SR (SR group), SR conversion with ibutilide (IBU group) and those who required DCCV after ibutilide failure (IBU-DCCV group). The presence of paroxysmal AF (ORcrude=6.42, 95% CI 1.63-25.3, P=0.0079), absence of diabetes (ORcrude=5.60, 95% CI 1.15-27.26, P=0.03) and lower BMI (ORcrude=0.93, 95% CI 0.87-0.99, P=0.02, for 1 kg/m2 increase in BMI) were individually associated with spontaneous cardioversion after ablation. The median time to recurrence of AT/AF (time to failure) for SR, IBU and IBU-DCCV groups were 211, 162.9 and 83 days respectively. The survival curves for the groups were not statistically different (P=0.22) even after adjustment for potential confounders (Figure 1). Duration of RF ablation (HRCrude=1.014, 95% CI 1.001-1.027, P=0.034) and the time since AF diagnosis (HRCrude=1.117, 95% CI 1.046-1.193, P=0.001) were the only baseline parameters associated with AF recurrence after ablation. Conversion to SR with ibutilide is not associated with long-term rhythm maintenance after AF ablation. None of the baseline clinical or procedural parameters predicted the likelihood of successful cardioversion with ibutilide after AF ablation.

İskemik Kalp Hastalığı Cerrahi Tedavisi Sonrası Gelişen Atriyal Fibrilasyon; Bir Yıllık, Tek Merkez, Tek Cerrah Sonuçlarımız

Introduction: Postoperative atrial fibrillation is the most common arrhythmia following bypass surgery with significant morbidity, mortality and increased healthcare costs. The aim of this study is to determine the incidence and timing of atrial fibrillation, identify the risk factors covering preoperative and intraoperative periods, evaluate rate of return to sinus rhythm by disharge, and explore the impact on postoperative outcomes in a large group of patients operated in a single center by a single surgeon. Patients and Methods: Between January 2011 and January 2012, 418 patients on preoperative sinus rhythm were operated for ischemic heart disease and associated complications (left ventricle aneurysm repair and ischemic mitral insufficiency) in a single center, by a single surgeon. The preoperative, intraoperative and postoperative variables were studied. Results: The mean age of the patients were 61.92 ± 10.05, and 77.5% were male. Atrial fibrillation developed in 68 (16.3%) patients. The incidence peaked at second day. Patients with atrial fibrillation were older (p< 0.001). Gender, preoperative comorbidities, ejection fraction, left atrial diameter, preoperative beta-blocker use, leukocyte count, type of operation and intraoperative variables did not affect its occurence. Intensive care unit and hospital length of stay were longer (p< 0.05). 95.5% (n= 65) of patients were in normal sinus rhythm at discharge. Conclusion: Postoperative atrial fibrillation is a popular subject with unknowns and controversial results which may lead to wrong interpretations. We believe that every center has its own risk Yazisma Adresi/ Correspondence Dr. Ahmet Baris Durukan Umit Mahallesi 2463. Sokak No: 4/18 Yenimahalle, Ankara-Turkiye e-posta barisdurukan@yahoo.com ORIJINAL ARASTIRMA • ORIGINAL INVESTIGATION Kosuyolu Kalp Dergisi 2012;15(2):65-74 Atrial Fibrillation Following Surgical Management of Ischemic Heart Disease; One Year, Single Center, Single Surgeon Results Iskemik Kalp Hastaligi Cerrahi Tedavisi Sonrasi Gelisen Atriyal Fibrilasyon; Bir Yillik, Tek Merkez, Tek Cerrah Sonuclarimiz Kosuyolu Kalp Dergisi 2012;15(2):65-74 66 INTRODuCTION Postoperative atrial fibrillation (POAF) is the most commonly encountered rhythm disturbance following coronary artery bypass grafting (CABG) surgery with significant inhospital and future morbidity, future mortality and increased health care costs. The incidence is reported in a wide range in different studies, but POAF occurs approximately in 30% of cases following isolated CABG procedures(1-3). Despite recent advances in surgical and anesthesiological applications, its incidence has increased and is expected to rise more in future due to aging of the population. It mostly occurs within two to four days following surgery and peaks on second day(1,4). It is defined as a major morbid event due to increased incidence of minor and major thromboembolic events, hemodynamic disturbances, ventricular dysrhythmias, iatrogenic complications related to therapeutic interventions, increased intensive care unit and hospital length of stay and mortality(1). There are innumerous documented and speculated risk factors for occurence of POAF. The most consistent ones are the age, male gender, history of prior atrial fibrillation, inceased left atrial diameter, decreased ejection fraction, chronic obstructive pulmonary disease (COPD), chronic renal failure, diabetes mellitus, obesity and concomitant valvular surgery(4-6). The aim of this study is to determine the incidence and timing of POAF; identify the risk factors associated with its occurence covering the preoperative and intraoperative periods; evaluate percentage of return to sinus rhythm by discharge; and find out the impact on postoperative outcomes in a large group of patients undergoing surgery for ischemic heart disease management, in a single center, by a single surgeon. MATERIALS and METhODS Four hundred and twenty two patients were operated for ischemic heart disease and associated complications (left ventricular aneurysm and ischemic mitral insufficiency) between January 2011 and January 2012. Four patients were excluded due to preoperative existing atrial fibrillation atrial fibrillation in whom radiofrequency ablation during surgery was performed. The Hospital Ethics Committee approved the study based on retrospective data retrieval, waiving for individual consent. The patients were factors related with the population of that region. Discussion will last, but simple precautions and close monitoring will help to minimize adverse outcomes.

Antithrombotic therapy and outcomes of patients with atrial fibrillation following primary percutaneous coronary intervention: results from the APEX-AMI trial

To assess the incidence and timing of atrial fibrillation (AF), describe antithrombotic therapy use, and evaluate the association of AF with 90 day mortality and other secondary clinical outcomes. We studied 5745 ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention (PCI) in APEX-AMI. Approximately 11% had AF during hospitalization. Atrial fibrillation prevalence at baseline and at discharge was 4.8% [confidence interval (CI) 4.3-5.4%] and 2.5% (CI 2.1-2.9%), respectively. The proportion of 5466 patients without AF at baseline who developed new onset AF was 6.3% (CI 5.6-6.9%). This corresponded to 9.3 cases of new onset AF/1000 patient days at risk. New onset AF was independently associated with 90 day mortality [adjusted hazard ratio (HR) 1.81; 95% CI 1.06-3.09; P = 0.029] after accounting for baseline covariates and in-hospital procedures and complications. New onset AF was associated with shock (adjusted HR 3.81; 95% CI 1.88-7.70; P = 0.0002), congestive heart failure (adjusted HR 2.66; 95% CI 1.74-4.06; P < 0.0001), and stroke (adjusted HR 2.98; 95% CI 1.47-6.04; P = 0.0024) in models accounting for baseline covariates. Of AF patients, 55% did not receive oral anticoagulation therapy at discharge. Among patients with coronary stents, 5.1% were discharged on triple therapy. Patients at highest risk of stroke (CHADS(2) score > or =2) were least likely to receive oral anticoagulation at discharge (39%). Warfarin use in patients with AF at discharge (43.4%) was associated with lower rates of 90 day mortality and stroke. Atrial fibrillation prevalence at baseline and at discharge was 4.8 and 2.5%, respectively. The proportion of patients who developed new onset AF was 6.3%. New onset AF was independently associated with 90 day mortality and was a marker of adverse outcomes in patients undergoing primary PCI.