Late postoperative atrial fibrillation after cardiac surgery: a national survey within the cardiac rehabilitation setting

Ambrosetti, Marco; Tramarin, Roberto; Griffo, Raffaele; Feo, Stefania De; Fattirolli, Francesco; Vestri, Annarita; Riccio, Carmine; Temporelli, Pier Luigi

doi:10.2459/jcm.0b013e328346a6d3

Cited by 23 publications

(18 citation statements)

References 8 publications

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“…In the present study, AF was inducible in the majority of patients, and the incidence of de novo EPoAF was 37% ( overall EPoAF: 43%), which is comparable to incidences reported by other investigators . However, a correlation between inducibility of AF and development of EPoAF was absent.…”

Section: Discussionsupporting

confidence: 85%

“…In another cohort, consisting of 571 CABG patients, EPoAF developed in 29%. Patients with EPoAF had an 8‐fold increase in the risk of LPoAF development during a 3‐year follow‐up period Ambrosetti followed 710 patients after CABG and/or VHS. The overall LPoAF prevalence was 11% and was associated with development of EPoAF.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, EPoAF is known to increase the risk of late postoperative AF (LPoAF), 6,8,9 yet the predictive value of intraoperative inducibility was never investigated. The latest European guidelines advise to consider long-term oral anticoagulants in cases of EPoAF as prevention for thromboembolic complications (Class IIa).…”

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confidence: 99%

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Intraoperative Inducibility of Atrial Fibrillation Does Not Predict Early Postoperative Atrial Fibrillation

Lanters

Teuwen

Yaksh

et al. 2018

JAHA

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BackgroundEarly postoperative atrial fibrillation (EPoAF) is associated with thromboembolic events, prolonged hospitalization, and development of late PoAF (LPoAF). It is, however, unknown if EPoAF can be predicted by intraoperative AF inducibility. The aims of this study are therefore to explore (1) the value of intraoperative inducibility of AF for development of both EPoAF and LPoAF and (2) the predictive value of de novo EPoAF for recurrence of LPoAF.Methods and ResultsPatients (N=496, 75% male) undergoing cardiothoracic surgery for coronary and/or valvular heart disease were included. AF induction was attempted by atrial pacing, before extracorporeal circulation. All patients were on continuous rhythm monitoring until discharge to detect EPoAF. During a follow‐up period of 2 years, LPoAF was detected by ECGs and Holter recordings. Sustained AF was inducible in 56% of patients. There was no difference in patients with or without AF before surgery (P=0.159), or between different types of surgery (P=0.687). In patients without a history of AF, incidence of EPoAF and LPoAF was 37% and 2%, respectively. EPoAF recurred in 58% patients with preoperative AF, 53% developed LPoAF. There were no correlations between intraoperative inducibility and EPoAF or LPoAF (P>0.05). EPoAF was not correlated with LPoAF in patients without a history of AF (P=0.116), in contrast to patients with AF before surgery (P<0.001).ConclusionsIntraoperative AF inducibility does not predict development of either EPoAF or LPoAF. In patients with AF before surgery, EPoAF is correlated with LPoAF recurrences. This correlation is absent in patients without AF before surgery.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

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Intraoperative Inducibility of Atrial Fibrillation Does Not Predict Early Postoperative Atrial Fibrillation

Lanters

Teuwen

Yaksh

et al. 2018

JAHA

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“…They proposed a trajectory whereby the highest risk occurs immediately after surgery with a second increase in risk occurring 48 h postoperatively. Despite the vast majority of cases occurring within the first week after surgery, late onset POAF is underappreciated and occurs at a rate of 4% after a patient is discharged from hospital . While POAF is typically self‐limited with an average duration of 11–12 h and 80% of cases self‐resolving to normal sinus rhythm within 24 h after initial onset , a substantial proportion of patients will experience a second episode .…”

Section: Postoperative Atrial Fibrillation After Cardiac Surgerymentioning

confidence: 99%

Postoperative atrial fibrillation in non‐cardiac and cardiac surgery: an overview

Bessissow

Khan

Devereaux

et al. 2015

Journal of Thrombosis and Haemostasis

163

158

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To cite this article: Bessissow A, Khan J, Devereaux PJ, Alvarez-Garcia J, Alonso-Coello P. Postoperative atrial fibrillation in non-cardiac and cardiac surgery: an overview. J Thromb Haemost 2015; 13 (Suppl. 1): S304-S12.Summary. Postoperative atrial fibrillation (POAF) is the most common perioperative cardiac arrhythmia. A major risk factor for POAF is advanced age, both in non-cardiac and cardiac surgery. Following non-cardiac surgery, it is important to correct reversible conditions such as electrolytes imbalances to prevent the occurrence of POAF. Management of POAF consists of rate control and therapeutic anticoagulation if POAF persists for > 48 h and CHADS 2 score > 2. After cardiac surgery, POAF affects a larger amount of patients. In addition to age, valve surgery carries the greatest risk for new AF. Rate control is the mainstay therapy in these patients. Prediction, prevention, and management of POAF should be further studied.

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“…In this Journal of Cardiovascular Medicine issue, Ambrosetti et al 1 deal with the interesting topic of late postoperative atrial fibrillation (POPAF). In their article, data from two large multicenter prospective studies, including up to 2644 patients from 165 cardiac rehabilitation facilities, were used to inquire about the incidence of late POPAF, its predictors and the impact of this arrhythmia on morbidity and healthcare costs.…”

mentioning

confidence: 99%

Late postoperative atrial fibrillation: minor surgery complication or major cardiovascular issue?

Capucci

Guerra

2011

Journal of Cardiovascular Medicine

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Late postoperative atrial fibrillation after cardiac surgery: a national survey within the cardiac rehabilitation setting

Abstract: A high level of suspicion for late POPAF, after discharge from surgery units, should be maintained due to the risk of occurrence, the low antiarrhythmic effect of common cardioprotective drugs and the impact on cardiovascular prognosis.

Cited by 23 publications

References 8 publications

Intraoperative Inducibility of Atrial Fibrillation Does Not Predict Early Postoperative Atrial Fibrillation

Intraoperative Inducibility of Atrial Fibrillation Does Not Predict Early Postoperative Atrial Fibrillation

Postoperative atrial fibrillation in non‐cardiac and cardiac surgery: an overview

Late postoperative atrial fibrillation: minor surgery complication or major cardiovascular issue?

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