Predictors of Late Atrial Fibrillation Recurrence After Cardiac Surgery.

Jeremy William; Kate Rowe; Joseph Hogarty; Xiaoman Xiao; Anita Shirwaiker; Jason E Bloom; Silvana Marasco; Adam Zimmet; Christopher Merry; Justin Negri; Atsuo Doi; Julian Gooi; David McGiffin; Jonathan M Kalman; Sandeep Prabhu; Peter M Kistler; Aleksandr Voskoboinik
Abstract
Although postoperative atrial fibrillation (POAF) frequently occurs early after cardiac surgery, there is a paucity of data evaluating predictors and timing of late atrial fibrillation (AF) recurrence. The authors sought to evaluate predictors of late AF recurrence in patients undergoing cardiac surgery. We retrospectively reviewed cardiac surgery patients from 2010 to 2018 with no preoperative diagnosis of AF or atrial flutter. We recorded incidence and timing of late AF recurrence, defined as occurring ≥12 months following surgery. 1,031 patients were included (mean age at surgery 64 ± 12 years, 74% male). Early POAF was recorded in 445 patients (43%). POAF was usually transient, with total AF duration <48 hours in 72% and reversion to sinus rhythm at discharge in 91%. At 4.7 ± 2.4 years follow-up, late AF occurred in 139 patients (14%). Median time to AF recurrence was 4.4 years post-surgery (Q1-Q3: 2.6-6.2 years). Late AF was significantly more likely among patients with early POAF than those without (23% vs 6%; P < 0.001), with highest incidence (38%) in those with POAF duration >48 hours. In a multivariable analysis, early POAF duration >48 hours was a significant predictor of late AF recurrence (HR: 5.9). Surgery type and CHA<sub>2</sub>DS<sub>2</sub>-VASc score were not predictive of late AF events. Post-operative AF episodes of duration ≥48 hours predict recurrent AF episodes over long-term follow-up after cardiac surgery. Implications for arrhythmia surveillance and anticoagulation in patients with longer duration POAF episodes require further study.
Journal JACC. CLINICAL ELECTROPHYSIOLOGY
ISSN 2405-5018
Published 01 Jul 2024
Volume 10
Issue 7 Pt 2
Pages 1711-1719
DOI 10.1016/j.jacep.2024.05.030
Type Journal Article
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