New Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting Increases the Incidence of Late-onset Atrial Fibrillation
Daisuke Endo, Taira Yamamoto, Jiyoung Lee, Kosuke Nishida, Atsumi Oishi, Akie Shimada, Satoshi Matsushita, Shizuyuki Dohi, Hiroaki Hata, Tohru Asai, Atsushi Amano
Juntendo University, Tokyo, Japan
BACKGROUND: Postoperative Atrial fibrillation (POAF) after cardiac surgery is the most frequent complication of 30 to 50%. Still, it is often transient, and it is common to return to sinus rhythm upon discharge. However, there are few reports about late-onset developed AF after cardiac surgery. Therefore, we investigated late-onset AF incidence and its risk factors after coronary artery bypass grafting (CABG).
METHODS: Among patients undergoing CABG including valvular surgery and/or aortic surgery between 2002 and 2019, 2822 patients with preoperative sinus rhythm were analyzed. Late-onset AF was defined as occurring after 3 months of surgery. Among 912 patients of postoperative AF during hospitalization (32.3%, POAF group) and 1910 patients of sinus rhythm (67.7%, Sinus group), 695 patients in the POAF group and 695 patients in the Sinus group matched 1: 1 using the propensity score method were compared. The mean follow-up was 5.8 years.
RESULTS: There was no difference in the patient characteristics between the two groups after matching. The POAF group had significantly longer intensive care unit stay and postoperative hospital stay, higher incidences of stroke, respiratory complications, and renal failure. The 10-year freedom from AF was 89.4% in the Sinus group and 76.0% in the POAF group (p<0.01). Cox proportional hazard model analysis revealed that postoperative AF, history of cerebral infarction, and concomitant aortic root or arch surgery were independent risk factors of late-onset AF.
CONCLUSIONS: Postoperative AF was an independent risk factor for late-onset AF after CABG. Careful rhythm observation is necessary because the incidence of late-onset AF after CABG is not small.