Predictors of Late Atrial Fibrillation Recurrence After Cardiac Surgery.

Autor: William J; The Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia., Rowe K; The Alfred Hospital, Melbourne, Victoria, Australia., Hogarty J; The Alfred Hospital, Melbourne, Victoria, Australia., Xiao X; The Alfred Hospital, Melbourne, Victoria, Australia., Shirwaiker A; The Alfred Hospital, Melbourne, Victoria, Australia., Bloom JE; The Alfred Hospital, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia., Marasco S; The Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia., Zimmet A; The Alfred Hospital, Melbourne, Victoria, Australia., Merry C; The Alfred Hospital, Melbourne, Victoria, Australia., Negri J; The Alfred Hospital, Melbourne, Victoria, Australia., Doi A; The Alfred Hospital, Melbourne, Victoria, Australia., Gooi J; The Alfred Hospital, Melbourne, Victoria, Australia., McGiffin D; The Alfred Hospital, Melbourne, Victoria, Australia., Kalman JM; University of Melbourne, Melbourne, Victoria, Australia; Royal Melbourne Hospital, Melbourne, Victoria, Australia., Prabhu S; The Alfred Hospital, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia., Kistler PM; The Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia; Royal Melbourne Hospital, Melbourne, Victoria, Australia., Voskoboinik A; The Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia. Electronic address: a.voskoboinik@alfred.org.au.
Jazyk: angličtina
Zdroj: JACC. Clinical electrophysiology [JACC Clin Electrophysiol] 2024 Jul; Vol. 10 (7 Pt 2), pp. 1711-1719.
DOI: 10.1016/j.jacep.2024.05.030
Abstrakt: Background: 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.
Objectives: The authors sought to evaluate predictors of late AF recurrence in patients undergoing cardiac surgery.
Methods: 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.
Results: 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 2 DS 2 -VASc score were not predictive of late AF events.
Conclusions: 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.
Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(Copyright © 2024. Published by Elsevier Inc.)
Databáze: MEDLINE
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