Atrial flutter after non-congenital cardiac surgery: Incidence, predictors and outcome

• Published in: International journal of cardiology Vol. 153; no. 2; pp. 196 - 201
• Main Authors: Fatemi, Marjaneh, Leledy, Marion, Le Gal, Grégoire, Bezon, Eric, Mondine, Philippe, Blanc, Jean-Jacques
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01.12.2011; Elsevier
• Subjects: Aged; Aged, 80 and over; Atrial Flutter; Atrial Flutter - diagnosis; Atrial Flutter - epidemiology; Atrial Flutter - physiopathology; Biological and medical sciences; Cardiac dysrhythmias; Cardiac surgery; Cardiac Surgical Procedures; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - trends; Cardiology. Vascular system; Cardiovascular; Female; Follow-Up Studies; Heart; Human health and pathology; Humans; Incidence; Life Sciences; Male; Medical sciences; Middle Aged; Outcome; Postoperative Complications; Postoperative Complications - diagnosis; Postoperative Complications - epidemiology; Postoperative Complications - physiopathology; Predictive Value of Tests; Predictors; Recurrence; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Treatment Outcome; Cardiac surgery; Outcome; Atrial flutter; Incidence; Predictors; Prognosis; Arrhythmia; Congenital; Predictor; Cardiovascular disease; Epidemiology; Excitability disorder; Heart disease; Cardiology; Predictive factor
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2010.08.021

Abstract Background Atrial arrhythmias (AAs) occur frequently after cardiac surgery. However, most authors do not differentiate postoperative atrial fibrillation (AF) from atrial flutter (AFL). Our study sought to investigate the incidence and predictors of AFL following non-congenital cardiac surgery, and the long-term outcome of this arrhythmia. Methods and results We conducted an observational, retrospective, single-centre study. Among 821 patients in sinus rhythm (SR) before non-congenital cardiac surgery, AFL occurred in 42 patients (5.1%) and AF in 77 (9.4%). Independent predictors of AAs were older age (odds ratio (OR): 1.06, 95% confidence interval (CI): 1.01–1.11, p = 0.02), low postoperative hemoglobin level (OR: 0.43, CI: 0.29–0.63, p < 0.0001) and long cross-clamp time (OR: 1.02, CI: 1.002–1.037, p = 0.03). Compared to AF patients, those with AFL were younger (67 ± 10 versus 72 ± 8 years, p = 0.005) and less likely to have valve surgery (57% versus 76%, p = 0.03). After conversion to SR, of 41/42 patients with AFL, 5 (12%) developed AFL and 5 (12%) had AF within a mean follow-up of 9.6 ± 8.4 months: only 32% of patients were on long-term antiarrhythmic therapy and 5% had radiofrequency ablation of AFL in the early postoperative period. Conclusion AFL following non-congenital cardiac surgery is not frequent. Compared to patients in AF, those with AFL are younger and less likely to have valve surgery. After conversion of AFL to SR, recurrence rate of AAs is relatively low. Therefore, AFL occurring in this setting does not require systematic catheter ablation in the postoperative period.