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

• Published in: Heart rhythm
• Main Authors: Gilbers, Martijn D., Kawczynski, Michal J., Bidar, Elham, Maesen, Bart, Isaacs, Aaron, Winters, Joris, Linz, Dominik, Rienstra, Michiel, van Gelder, Isabelle, Maessen, Jos G., Schotten, Ulrich
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 08.08.2024
• Subjects: Atrial fibrillation burden; Cardiac surgery; Clinical predictors; Postoperative atrial fibrillation; Risk assessment; Clinical predictors; POAF; AF; CI; V-rate; ATEF; RAVImax; Cardiac surgery; Postoperative atrial fibrillation; ER; LATEF; ILR; Risk assessment; St. Beta; Atrial fibrillation burden
• ISSN: 1547-5271; 1556-3871; 1556-3871
• DOI: 10.1016/j.hrthm.2024.08.014

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. 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). 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. 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). 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.