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High incidence of atrial fibrillation after coronary surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
2016 (English)In: Interactive Cardiovascular and Thoracic Surgery, ISSN 1569-9293, E-ISSN 1569-9285, Vol. 22, no 2, 176-180 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Postoperative atrial fibrillation (POAF) affects a third of all patients after coronary artery bypass surgery (CABG), but short-term follow-up of heart rhythm after discharge has been sporadic and shown varied results. The aim of this study was to examine the incidence of post-discharge atrial fibrillation (AF) for 30 days following hospital discharge after CABG.

METHODS: A total of 67 patients, 19 (28%) with POAF during the initial hospitalization and 48 (72%) without POAF were included. Patients recorded intermittent electrocardiogram registrations three times daily, and additionally in case of arrhythmia symptoms. Presence of post-discharge AF was compared between the groups. All patients were in sinus rhythm at discharge.

RESULTS: Twenty of 67 patients (30%) were diagnosed with post-discharge AF. Overall, 35% of them were entirely asymptomatic. POAF patients had a higher incidence of post-discharge AF (11 of 19, 58%) than non-POAF patients (9 of 48, 19%), with six times the odds of developing post-discharge AF compared with non-POAF patients [odds ratio (OR) 6.0; 95% CI 1.9-19, P = 0.002]. Patients with POAF registered episodes of post-discharge AF earlier during the follow-up period (mean Day 3 after discharge, range 1-9 days) than non-POAF patients (Day 10, range 7-14 days, P < 0.001).

CONCLUSIONS: A high incidence of both symptomatic and asymptomatic AF was recorded during 30 days following hospital discharge after CABG. The incidence was highest among patients with POAF, of whom more than half experienced post-discharge AF.

Place, publisher, year, edition, pages
2016. Vol. 22, no 2, 176-180 p.
Keyword [en]
Parastomal hernia, Mesh, Surgery, Rectal cancer, Colostomy
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-269580DOI: 10.1093/icvts/ivv326ISI: 000372420100010PubMedID: 26598007OAI: oai:DiVA.org:uu-269580DiVA: diva2:883386
Available from: 2015-12-17 Created: 2015-12-17 Last updated: 2017-12-01Bibliographically approved
In thesis
1. Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting: Risk factors and clinical outcome
Open this publication in new window or tab >>Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting: Risk factors and clinical outcome
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Postoperative atrial fibrillation (POAF) is a common complication after coronary artery bypass grafting (CABG), and more knowledge is needed regarding prediction of POAF, the extent of early atrial fibrillation (AF) recurrence after discharge, and the associations between POAF and short and long-term overall and cause-specific mortality and morbidity.

After CABG, 31-32% of all patients developed POAF. Several independent risk factors were identified, including increasing age, preoperative S-creatinine ≥150 µmol/l, male gender, NYHA class III/IV, current smoking, prior myocardial infarction (MI), and absence of hyperlipidaemia. The discriminatory ability of the final prediction model was moderate. POAF patients had a higher incidence of early postoperative complications, including stroke and heart failure (HF) and longer hospital stays. In-hospital mortality did not differ between groups.

In long-term follow-up, POAF was independently associated with increased risk of late cardiac mortality after CABG. Examining both underlying and contributing causes of death, POAF was associated with death related to arrhythmia, cerebrovascular disease and HF. The associations remained for more than 8 years.

Observation of heart rhythm during the 30 days following discharge after CABG revealed that 30% of all patients experienced episodes of post-discharge AF. Of all patients with AF, 35% did not experience any symptoms. Patients with POAF had a higher incidence of post-discharge AF, but high incidences were recorded both for patients with POAF (58%) and with sinus rhythm (19%) in-hospital.

POAF was associated with increased long-term risk of overall, cardiac and cerebrovascular mortality, ischemic stroke and HF, and displayed higher incidence rates of these morbidities after CABG. Furthermore, POAF was recognised as a recurrent condition where AF in relation to surgery was a precursor to both first and subsequent events of AF during follow-up. Occurrence of AF, HF, MI and ischemic stroke during follow-up further increased overall mortality.

In conclusion, POAF is common after CABG and remains hard to accurately predict. POAF patients experience more postoperative complications, a higher incidence of post-discharge AF and a recurrent pattern of AF long-term. POAF is also associated with an increased risk of cardiovascular-related mortality, and ischemic stroke and HF in long-term follow-up.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. 62 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1391
Keyword
atrial fibrillation, coronary artery bypass grafting, coronary artery disease, epidemiology, morbidity, mortality, outcome
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-332125 (URN)978-91-513-0133-4 (ISBN)
Public defence
2017-12-18, Robergsalen, Akademiska sjukhuset, Ing 40, 4 tr, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2017-11-24 Created: 2017-10-26 Last updated: 2017-11-24

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Thorén, EmmaHellgren, LailaStåhle, Elisabeth

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