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Clinical Course of Postoperative Atrial Fibrillation After Cardiac Surgery and Long-term Outcome

Clinical Course of Postoperative Atrial Fibrillation After Cardiac Surgery and Long-term Outcome


Title: Clinical Course of Postoperative Atrial Fibrillation After Cardiac Surgery and Long-term Outcome
Author: Rezk, Mary
Taha, Amar
Nielsen, Susanne J.
Gudbjartsson, Tomas   orcid.org/0000-0002-7281-5749
Bergfeldt, Lennart
Ahlsson, Anders
Jeppsson, Anders
Date: 2022-12-01
Language: English
Scope: 7
Department: Faculty of Medicine
Cardio-Vascular Center
Series: Annals of Thoracic Surgery; 114(6)
ISSN: 0003-4975
DOI: https://doi.org/10.1016/j.athoracsur.2022.03.062
Subject: Humans; Atrial Fibrillation/epidemiology; Retrospective Studies; Risk Factors; Postoperative Complications/etiology; Cardiac Surgical Procedures/adverse effects; Thromboembolism/etiology; Hemorrhage; Heart Failure/complications; Cardiology and Cardiovascular Medicine; Pulmonary and Respiratory Medicine; Surgery
URI: https://hdl.handle.net/20.500.11815/3835

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Citation:

Rezk , M , Taha , A , Nielsen , S J , Gudbjartsson , T , Bergfeldt , L , Ahlsson , A & Jeppsson , A 2022 , ' Clinical Course of Postoperative Atrial Fibrillation After Cardiac Surgery and Long-term Outcome ' , Annals of Thoracic Surgery , vol. 114 , no. 6 , pp. 2209-2215 . https://doi.org/10.1016/j.athoracsur.2022.03.062

Abstract:

BACKGROUND: New-onset postoperative atrial fibrillation (POAF) after cardiac surgery is associated with worse short- and long-term outcomes. Although the clinical presentation of POAF varies substantially, almost all studies model it with a dichotomous yes or no variable. We explored potential associations between the clinical course of POAF and long-term outcome. METHODS: This retrospective, observational, single-center study included 6435 coronary artery bypass grafting and/or valve patients between 2010 and 2018. POAF patients were grouped into spontaneous/pharmacologic conversion to sinus rhythm, sinus rhythm after electrical cardioversion, and sustained AF at discharge. Multivariable Cox regression models adjusted for age, sex, type of surgery, comorbidities, and early-initiated oral anticoagulation were used to study associations between the clinical course of POAF and long-term risk for mortality, ischemic stroke, thromboembolic events, heart failure hospitalization, and major bleeding. Median follow-up time was 3.8 years (range, 0-8.3). RESULTS: POAF occurred in 2172 patients (33.8%), 94.9% of whom converted to sinus rhythm before discharge. Of these, 73.6% converted spontaneously or with pharmacologic treatment and 26.4% after electrical cardioversion. Both sustained AF and electrical cardioversion were independently associated with an increased long-term risk for heart failure (adjusted hazard ratio for sustained AF at discharge, 2.55 [95% confidence interval, 1.65-3.93; P < .001]; adjusted hazard ratio for electrical cardioversion, 1.28 [95% confidence interval, 1.00-1.65; P = .049]) but not with increased long-term risk for death, thromboembolic complications, or bleeding. CONCLUSIONS: A more complicated POAF course is associated with increased long-term risk for heart failure hospitalization but not for all-cause mortality or thromboembolic complications.

Description:

Funding Information: The study was supported by the Swedish Heart-Lung Foundation (grant 20180560 to AJ), the Swedish state (ALFGBG-725131 to AJ) under the agreement between the Swedish government and the county councils concerning economic support of research and education of doctors (ALF agreement), Region Västra Götaland (grant VGFOUREG-847811 to AJ and grant VGFOUREG-648981 to AT), and Wilhelm and Martina Lundgrens Foundation (grant 2019-3110 to AT). The authors had full freedom of investigation and full control of the design of the study, analysis of data, and production of the written report. Dr Jeppsson discloses a financial relationship with Boehringer-Ingelheim, XVIVO, Portola, Baxter, and LFB; Dr Taha with Bayer; Dr Bergfeldt with Bayer, Boehringer Ingelheim, and Sanofi. Funding Information: The study was supported by the Swedish Heart-Lung Foundation (grant 20180560 to AJ), the Swedish state (ALFGBG-725131 to AJ) under the agreement between the Swedish government and the county councils concerning economic support of research and education of doctors (ALF agreement), Region Västra Götaland (grant VGFOUREG-847811 to AJ and grant VGFOUREG-648981 to AT), and Wilhelm and Martina Lundgrens Foundation (grant 2019-3110 to AT). The authors had full freedom of investigation and full control of the design of the study, analysis of data, and production of the written report. Publisher Copyright: © 2022 The Society of Thoracic Surgeons

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