What is the clinical evidence from this study?

Study design: Cohort. Population: Postoperative atrial fibrillation after cardiac surgery (n=98). Intervention: Early postoperative atrial fibrillation (POAF) burden. Primary outcome: Late-POAF (re)occurrence (HR 1.93, 95% CI 1.42-2.62, p=<.001).

August 8, 2024Heart Rhythm11 citationsOpen Access

Determinants and impact of postoperative atrial fibrillation burden during 2.5 years of continuous rhythm monitoring after cardiac surgery: Results from the RACE V prospective cohort study

Q: What are the key findings of this study?

Greater early postoperative atrial fibrillation burden was significantly associated with an increased risk of late-POAF recurrence (adjusted HR 1.93; 95% CI 1.42-2.62; P<.001).

MGMartijn GilbersMaastricht University Medical Centre MKMichał KawczyńskiCardiac Surgery EBElham BidarCardiac Surgery

Key Result

Greater early postoperative atrial fibrillation burden was significantly associated with an increased risk of late-POAF recurrence (adjusted HR 1.93; 95% CI 1.42-2.62; P<.001).

Study Design

Type

Cohort (n=98)

Structured PICO

Does early postoperative atrial fibrillation burden predict late postoperative atrial fibrillation recurrence in patients undergoing cardiac surgery?

Population

98 consecutive patients undergoing cardiac surgery, continuously monitored with an implantable loop recorder for 2.5 years.

Exposure

Continuous rhythm monitoring with an implantable loop recorder

Outcome

Distribution of postoperative atrial fibrillation (POAF) burden and association between early-POAF burden (within first 90 days) and late-POAF recurrences (after 90 days)surrogate

Greater early postoperative atrial fibrillation burden is significantly associated with increased late POAF incidence, suggesting its utility in estimating long-term recurrence risk.

Main Result

Hazard Ratio: 1.93 (95% CI 1.42–2.62)

p-value: p=<.001

Abstract

BACKGROUND: Early postoperative atrial fibrillation (POAF) is common after cardiac surgery and is associated with late-POAF recurrences. However, little is known about the burden of POAF and its potential impact on long-term outcomes after cardiac surgery, particularly on the risk for late-POAF recurrences. OBJECTIVE: The purpose of this study was to establish the distribution of POAF burden and to determine the association between early-POAF burden and late-POAF recurrences during 2.5 years of continuous rhythm monitoring after cardiac surgery in patients with and without preoperative history of atrial fibrillation (AF). METHODS: Patients undergoing cardiac surgery were prospectively enrolled and postoperatively continuously monitored with an implantable loop recorder for 2.5 years. All patients underwent extensive clinical assessment at baseline. During follow-up, all AF episodes were registered, and AF associated metrics, such as burden, were calculated for different time intervals. Early-POAF was defined as AF within first 90 postoperative days and late-POAF as AF after this interval. RESULTS: A total of 98 consecutive patients were included. POAF burden during the early postoperative phase was significantly higher compared to the late postoperative phase (P <.001). The longest individual POAF episode was strongly associated with increased POAF burden after adjusting for age, sex, and AF history (standardized Beta: 0.91, P <.001). Also, early-POAF burden was associated with late-POAF (re)occurrence after adjusting for age, sex, AF history (adjusted hazard ratio 1.93, 95% confidence interval 1.42-2.62, P <.001). CONCLUSION: POAF burden was significantly associated with the longest individual POAF episode duration. Additionally, greater early-POAF burden was associated with increased late-POAF incidence, highlighting its potential in estimating the risk for long-term POAF recurrences.

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