Key result
POAF shows no significant link to 1-year stroke or vascular death after cardiac surgery.
Why the study?
New-onset AF is the most common complication of cardiac surgery, but current understanding of its incidence, management, and relationship to long-term outcomes primarily derives from registries and single-centre studies.
Does new-onset postoperative atrial fibrillation increase the risk of stroke, vascular death, or all-cause death in adults undergoing cardiac surgery?
Cohort (n=12,234)
Yes
Does new-onset postoperative atrial fibrillation increase the risk of stroke, vascular death, or all-cause death in adults undergoing cardiac surgery?
Effect estimate: aHR 1.32 (95% CI 0.99-1.77)
Absolute Event Rate: 2.3% vs 1.5%
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Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“One of the goals of these guidelines was not to promote a single dominant therapy, but to provide a structured, phase-based approach that can reduce unwarranted practice variation while still allowing clinical judgment.”
“When we started this project, all nine members had their own way to address atrial fibrillation occurring de novo after cardiac surgery. The time spent discussing and reviewing helped us recalibrate our stance and recognize how limited the evidence truly is for many commonly used interventions.”
New-onset postoperative atrial fibrillation occurs in nearly a third of cardiac surgery patients and is associated with significantly increased risks of subsequent clinical atrial fibrillation and all-cause mortality at 1 year.
Background and Aims New-onset atrial fibrillation (AF) is the most common complication of cardiac surgery. We aimed to describe the incidence of postoperative AF (POAF), its management, and its relationship to long-term outcomes in a prospective multi-centre cohort, as our current understanding comes primarily from registries and single-centre studies. Methods VISION Cardiac Surgery was a prospective cohort of adults who underwent cardiac surgery in 12 countries. The association of POAF with outcomes occurring between 30 days and 1 year postoperatively was estimated using a multivariable Cox model adjusted for patient and operative characteristics and for antithrombotic therapies. Results Among 12 234 patients (55.3% isolated coronary artery bypass grafting), 31.8% had POAF within 30 days of surgery. The proportion of participants with POAF who received anticoagulation alone at hospital discharge was 15.6%, 54.3% received antiplatelets alone, 23.9% received anticoagulation and antiplatelets, and 6.3% received neither; 48.8% were receiving amiodarone. At 1 year, clinical AF was detected in 6.9% of patients with POAF compared to 0.6% in those without [adjusted hazard ratio (aHR), 11.30; 95% confidence interval (CI) 8.17–15.70]. The primary composite outcome of stroke or vascular death occurred in 2.3% of patients with POAF and 1.5% in those without POAF (aHR 1.32; 95% CI 0.99–1.77). Patients with POAF had a higher risk of all-cause death (3.0% vs 1.7%; aHR 1.54; 95% CI 1.18–2.00). Conclusions New-onset POAF occurs in a third of patients after cardiac surgery; its antithrombotic and antiarrhythmic management varies. Patients with POAF have increased risks of both clinical AF and of all-cause death in the year following surgery.
McIntyre et al. (2026) conducted a cohort in Postoperative atrial fibrillation (n=12,234). Postoperative atrial fibrillation vs. No postoperative atrial fibrillation was evaluated on Composite outcome of stroke or vascular death (aHR 1.32, 95% CI 0.99-1.77). Postoperative atrial fibrillation after cardiac surgery was associated with a 1-year rate of stroke or vascular death of 2.3% versus 1.5% without POAF (aHR 1.32; 95% CI 0.99-1.77).
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