Management of Postoperative Atrial Fibrillation and Subsequent Outcomes in Contemporary Patients Undergoing Cardiac Surgery: Insights From the Society of Thoracic Surgeons CAPS‐Care Atrial Fibrillation Registry

Abstract

Background Post-operative atrial fibrillation (POAF) is a well-recognized complication of cardiac surgery, however, its management remains a challenge and the implementation and outcomes of various strategies in clinical practice remain unclear. Methods We compared patient characteristics, operative procedures, post-operative management, and outcomes between patients with and without POAF following coronary artery bypass grafting (CABG) in the Society for Thoracic Surgery multicenter CAPS-Care registry (2004–2005). Results Of 2,390 patients who underwent CABG, 676 (28%) had POAF. Compared with patients without POAF, those with POAF were older (median age 74 vs. 71, p<0.0001), more likely to have hypertension (86% vs. 83%, p=0.04), and impaired renal function (median estimated glomerular filtration rate, 56.9 vs. 58.6 mL/min/1.73m2, p=0.0001). A majority of patients with POAF were treated with amiodarone (77%) and beta-blockers (68%); few underwent cardioversion (9.9%). Patients with POAF were more likely to experience complications (57% vs.41%, p<0.0001), including acute limb ischemia (1.0% vs. 0.4%, p=0.03), stroke (4% vs. 1.9%, p=0.002), and reoperation (13% vs. 7.9%, p<0.0001). Length of stay (median 8 days vs. 6 days, p<0.0001), in-hospital mortality (6.8% vs. 3.7%, p=0.001), and 30-day mortality (7.8 vs. 3.9, p<0.0001) were all worse for patients with POAF. In adjusted analyses, POAF remained associated with increased length of stay following surgery (adjusted ratio of the mean 1.27, 95% CI 1.2–1.34, p<0.0001). Conclusions In conclusion, post-operative AF is common following CABG, and such patients continue to have higher rates of post-operative complications. Post-operative AF is significantly associated with increased length of stay following surgery.

2018 ESC/EACTS Guidelines on myocardial revascularization

“…[411][412][413][414] The main risk factor for post-operative AF is age, and it is associated with an increased immediate risk of stroke, increased morbidity, and 30 day mortality. [415][416][417] In the long-term, patients…”

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…Migotanie przedsionków jest częste po operacjach serca (występuje u 15-45% pacjentów) [924][925][926] i wiąże się z wydłużeniem pobytu w szpitalu, większą częstością występowa-nia powikłań oraz większą śmiertelnością [927]. W okresie pooperacyjnym AF nierzadko występuje po innych dużych operacjach, zwłaszcza u pacjentów w podeszłym wieku.…”

“…Migotanie przedsionków w okresie pooperacyjnym wią-że się ze zwiększonym ryzykiem wczesnego udaru mózgu, chorobowości, a także umieralności w 30-dniowej obserwacji [927,951,952]. Długoterminowo u pacjentów z epizodem AF w okresie pooperacyjnym stwierdza się 2-krotny wzrost umieralności z przyczyn sercowo-naczyniowych oraz znacznie zwiększone ryzyko AF i udaru niedokrwiennego w przyszłości w porównaniu z pacjentami, u których po operacji utrzymywał się rytm zatokowy [952][953][954][955][956][957][958].…”

Magnesium for Atrial Fibrillation, Myth or Magic?

“…2 AF is not only prevalent in the general population (≈3%, with much higher rates in older patients) but also a frequent comorbidity and risk factor in patients with a range of cardiovascular conditions, including heart failure and after cardiac surgery. 3,4 Identifying practical and effective methods for managing AF is a clinical imperative.…”