What question did this study set out to answer?

This research aims to identify the incidence and risk factors of atrial fibrillation following defibrillator implantation.

March 1, 1995Pacing and Clinical Electrophysiology

Atrial Fibrillation After Implantable Cardioverter Defibrillator Implantation

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Why the study?

Does the operative approach (thoracotomy vs nonthoracotomy) affect the incidence of postoperative atrial fibrillation in patients undergoing implantable cardioverter defibrillator implantation?

Key Points

This research aims to identify the incidence and risk factors of atrial fibrillation following defibrillator implantation.
Reviewed data from 117 patients undergoing defibrillator implantation via thoracotomy (n=71) or nonthoracotomy (n=46).
Analyzed 15 potential predictive variables for atrial fibrillation.
Conducted multivariate analysis to determine significant independent risk factors.
Atrial fibrillation occurred in 26/117 patients (22%) during early postoperative period, predominantly in thoracotomy group (P<0.001).
Older age (63 vs 58 years, P=0.04) and prior history of paroxysmal atrial fibrillation (31% vs 10%, P=0.02) were noted in patients with atrial fibrillation.
Significant independent variables included operative approach (P<0.001), absence of antiarrhythmic therapy (P=0.006), and prior atrial fibrillation history (P=0.003).

Structured PICO

Does the operative approach (thoracotomy vs nonthoracotomy) affect the incidence of postoperative atrial fibrillation in patients undergoing implantable cardioverter defibrillator implantation?

Population

117 patients who underwent implantable cardioverter defibrillator implantation via a thoracotomy (n = 71) or nonthoracotomy (n = 46) approach

Intervention

Thoracotomy approach for defibrillator implantation

Comparator

Nonthoracotomy approach for defibrillator implantation

Outcome

Incidence of atrial fibrillation during the early postoperative periodsafety

Postoperative atrial fibrillation is a common complication after ICD implantation via thoracotomy and can lead to inappropriate defibrillator discharges.

Implication

Thoracotomy approach was associated with higher postoperative AF after ICD implantation; leaves open whether antiarrhythmic prophylaxis reduces risk.

Abstract

Atrial fibrillation is a reported complication of automatic defibrillator implantation. Its incidence, risk factors, time-course, and complications have not been well-defined. Accordingly, data from 117 patients who underwent defibrillator implantation via a thoracotomy (n = 71) or nonthoracotomy (n = 46) approach were reviewed. To identify risk factors, 15 variables of potential predictive value were chosen and analyzed. Atrial fibrillation developed in 26/117 patients (22%) during the early postoperative period and all but one of these 26 patients had undergone thoracotomy (P < 0.001). Patients who developed atrial fibrillation tended to be older than those who did not (63 +/- 2 vs 58 +/- 2 years, P = 0.04) and more frequently had a prior history of paroxysmal atrial fibrillation (31% vs 10%, P = 0.02). They were also less likely to be taking Class I or III antiarrhythmic drugs (1/26 vs 24/91, P = 0.01). By multivariate analysis, operative approach (P < 0.001), the absence of antiarrhythmic drug therapy (P = 0.006), and a prior history of atrial fibrillation (P = 0.003) were significant independent variables. Digoxin neither prevented the occurrence of atrial fibrillation nor slowed the maximal ventricular response. The mortality and complication rates did not differ between the two groups. The major adverse effect of postimplant atrial fibrillation was automatic defibrillator discharge; six patients received between 1 and 11 discharges for atrial fibrillation with rapid ventricular rates.