Factors associated with negative outcomes in post-operative atrial fibrillation

Atrial fibrillation (AF) duration is a risk marker for adverse cardiac events for up to 1 year following cardiac surgery, according to the analysis of a large cohort.

VISION Cardiac Surgery is a prospective cohort including 15,971 patients from 12 countries [1]. Dr William McIntyre (Population Health Research Institute, Canada) presented an analysis that included participants without a history of AF who either developed post-operative AF or did not. The analysis assessed characteristics associated with AF and clinical events between 30 days and 1 year following surgery. Outcomes were analysed in association with AF at hospital discharge, receiving electrical cardioversion, and estimated AF duration of >72 hours, 48–72 hours, 24–48 hours, and <24 hours.

Thirty-two per cent (n=3,887) of participants in the cohort had post-operative AF. Almost half of these participants had AF lasting <24 hours. The composite outcome of vascular death or stroke in participants with versus without AF was associated with AF at discharge (adjusted HR 1.72; 95% CI 1.03–2.87) and with receiving electrical cardioversion (adjusted HR 2.18; 95 %CI 1.16–4.11) but not with the other characteristics.

Additionally, the development of stroke was associated with AF lasting >72 hours only (adjusted HR 2.42; 95% CI 1.15–5.09), while the development of congestive heart failure was associated with the presence of AF at discharge only (adjusted HR 2.63; 95% CI 1.49–4.63). Finally, all-cause mortality in participants with AF versus participants without AF was associated with AF at discharge (adjusted HR 1.83; 95% CI 1.10–3.05) and receiving electrical cardioversion (adjusted HR 2.81; 95% CI 1.67-4.73).

“In patients with new-onset, post-operative AF following cardiac surgery, longer durations of AF appear to be markers of cardiac events; electrical cardioversion appears to be a marker of risk but only for all-cause mortality,” concluded Dr McIntyre.

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   1. McIntyre WF, et al. Association of the pattern of new-onset post-operative atrial fibrillation with adverse clinical events over 1 year follow-up: insights from the VISION Cardiac Surgery Cohort. Atrial fibrillation: clinical 1. EHRA Congress 2024, 7–9 April, Berlin, Germany.

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Posted on 29 April, 202429 April, 2024