New-onset of postoperative atrial fibrillation is likely to recur in the absence of other triggers

Abstract

BackgroundIncident atrial fibrillation (AF) is reported in 10%–65% of patients without previous AF diagnosis after open heart surgery. The risk of late AF recurrence after a postoperative AF onset is unclear, and it is controversial whether AF limited to the postoperative period should elicit oral anticoagulation (OAC) therapy. The primary objective of this study was to evaluate the long-term recurrence of AF in patients developing new-onset peri-procedural AF.Patients and methodsPatients (n=189) with available baseline and follow-up data included in Left Atrial Appendage Closure with Surgery trial were coded for known AF at baseline and for postoperative first-time AF diagnosis. AF occurrence was classified as follows: peri-procedural ≤7 days postoperatively, early >7 days but ≤3 months and late >3 months. Patients with no AF recurrence registered during follow-up were invited to undergo Holter monitoring.ResultsA total of 163 (86.2%) patients had no history of AF. Among these, 80 (49.1%) developed new-onset peri-procedural AF. After a mean follow-up of 3.7±1.6 years, late AF occurred in 35 of the 80 (43.8%) patients who developed peri-procedural AF and in 6 additional patients (7.2%) who remained in sinus rhythm until discharge (hazard ratio [HR] 9.3, 95% CI 3.8–22.4, p<0.001). Patients with peri-procedural AF and early AF had 12.24 times higher risk of late AF (95% CI 4.76–31.45, p<0.001) as compared to the group with no postoperative AF.ConclusionNew-onset of AF after open heart surgery has a high rate of recurrence and should not be regarded as a self-limiting phenomenon secondary to surgery.

Critical illness associated new onset atrial fibrillation: subsequent atrial fibrillation diagnoses and other adverse outcomes

“…15 However, the risk of subsequent AF diagnosis following CI-NOAF was previously unknown, with only a few, small studies involving selected post-surgical cohorts. [4][5][6] Amongst post-cardiac surgical patients, Ahlsson et al found NOAF to be associated with an 8-fold increase (25.4% vs. 3.6%) in subsequent AF diagnosis at a median follow-up of 5.3 years, 5 and Park-Hansen reported a 9-fold increase (43.8% vs. 7.2%) at 3.7 years. 6 In a broader post-operative NOAF population, AF recurrence rates were reported at 12.5% after mean follow-up of 943 days, with no difference between cardiac and non-cardiac surgical groups.…”

“…[4][5][6] Amongst post-cardiac surgical patients, Ahlsson et al found NOAF to be associated with an 8-fold increase (25.4% vs. 3.6%) in subsequent AF diagnosis at a median follow-up of 5.3 years, 5 and Park-Hansen reported a 9-fold increase (43.8% vs. 7.2%) at 3.7 years. 6 In a broader post-operative NOAF population, AF recurrence rates were reported at 12.5% after mean follow-up of 943 days, with no difference between cardiac and non-cardiac surgical groups. 4 No identified previous studies had evaluated the long-term risk of subsequent AF in unselected or non-surgical critically ill populations with NOAF.…”

“…It is also currently unclear whether CI-NOAF can be regarded as an isolated event, or predicts subsequent AF episodes long-term. Existing data primarily arise from selected critically ill subgroups, such as surgical cohorts [4][5][6] or patients with sepsis, 7 with no identified studies performed amongst an unselected critically unwell population.…”

Left Atrial Mechanical Function Predicts Postoperative AF in Patients with Rheumatic Mitral Valve Disease Who Underwent Mitral Valve Surgery

“…Reported incidences of early postoperative AF (PoAF) range from 10% to 65% [Mathew 2004;Zhang 2018]. Furthermore, early PoAF is known to increase the risk of late PoAF [Lanters 2018;Lee 2014], which has a high mortality rate [Park-Hansen 2018;Kawamoto 2018;Magruder 2016]. Patients who undergo surgical mitral valve replacement (MVR) for rheumatic mitral disease are at risk for developing PoAF, even after valve replacement [Park-Hansen 2018].…”

“…Furthermore, early PoAF is known to increase the risk of late PoAF [Lanters 2018;Lee 2014], which has a high mortality rate [Park-Hansen 2018;Kawamoto 2018;Magruder 2016]. Patients who undergo surgical mitral valve replacement (MVR) for rheumatic mitral disease are at risk for developing PoAF, even after valve replacement [Park-Hansen 2018]. It is well documented that enlargement of the left atrium is associated with AF and its recurrence in patients with rheumatic mitral disease Wang 2019;].…”