Dual-modality ambulatory ECG monitoring detected late postoperative atrial fibrillation in 38.2% of adults after CABG or SAVR, effectively doubling the AF diagnoses compared to early in-hospital monitoring (18.2%).
Does dual-modality ambulatory ECG monitoring up to 30 days improve the detection of late postoperative atrial fibrillation in patients undergoing CABG or SAVR?
Extending ambulatory ECG monitoring to 30 days post-discharge significantly improves the detection of late postoperative atrial fibrillation after CABG or SAVR compared to 10-day monitoring alone.
Effect estimate: OR 3.70 for female sex association with late POAF (95% CI 95% CI 1.17–11.72 for OR)
Absolute Event Rate: 38.2% vs 18.2%
p-value: p=0.025 for association of early POAF with late POAF; 0.026 for female sex with late POAF
Background: Postoperative atrial fibrillation (POAF) after cardiac surgery is common and clinically relevant, yet optimal postdischarge ECG surveillance remains undefined. We assessed the incidence of POAF after isolated coronary artery bypass grafting (CABG) and surgical aortic valve replacement (SAVR) using a dual-modality ambulatory strategy. Methods: In an exploratory, single-center study, consecutive adults without pre-operative AF undergoing elective isolated CABG or SAVR received dual-modality monitoring after discharge: continuous patch-Holter for ~10 days and a patient-activated single-lead recorder for up to 30 days. Early POAF was AF/AFl during index hospitalization; late POAF was first AF/AFL detected postdischarge by either modality. Results: Fifty-five patients were enrolled (CABG 30 54.5%, SAVR 25 45.5%; mean age 64.6 ± 9.8 years; 38.2% women). Early POAF occurred in 10/49 (20.4%); late POAF was detected in 21/55 (38.2%). By modality, late AF was identified on the 10-day Holter in 11/51 (21.6%) and on the 30-day recorder in 19/51 (37.3%). Cumulative detection reached 20.0% by day 7, 30.9% by day 10, and 38.2% thereafter, demonstrating that a substantive proportion of late POAF occurred after day 10, and 19/21 (90%) were captured by event monitoring. Female sex was independently associated with late POAF (OR 3.70, 95% CI 1.17–11.72); longer aortic cross-clamp time was related to late POAF in the SAVR subset, while larger LA size was related to POAF incidence in the CABG group. Early (in-hospital) POAF was associated with subsequent late POAF (p = 0.025). The difference in late POAF frequency between CABG and SAVR (33.3% vs. 44.0%; p = 0.42) was not significant. Conclusions: Among patients without prior AF undergoing CABG or SAVR, late POAF is frequent and often manifests beyond 10 days after discharge. Extending ambulatory surveillance to 30 days—or adopting a 10-day continuous plus patient-activated to day 30 hybrid—materially improves case finding and should be considered in routine postoperative pathways.
Kułach et al. (Thu,) conducted a other in Adults without prior atrial fibrillation undergoing elective isolated coronary artery bypass grafting (CABG) or isolated surgical aortic valve replacement (SAVR) (n=55). Dual-modality ambulatory ECG monitoring (10-day continuous Holter patch plus 30-day patient-activated single-lead event recorder) for detection of postoperative atrial fibrillation vs. Standard in-hospital telemetry monitoring was evaluated on Incidence of late postoperative atrial fibrillation/flutter detected by any ambulatory ECG modality postdischarge (OR 3.70 for female sex association with late POAF, 95% CI 95% CI 1.17–11.72 for OR, p=0.025 for association of early POAF with late POAF; 0.026 for female sex with late POAF). Dual-modality ambulatory ECG monitoring detected late postoperative atrial fibrillation in 38.2% of adults after CABG or SAVR, effectively doubling the AF diagnoses compared to early in-hospital monitoring (18.2%).