High Incidence of New-Onset Atrial Fibrillation After Cardiac Surgery: Study
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Canada: A large international cohort study published in the European Heart Journal has revealed that new-onset atrial fibrillation (AF) occurs in approximately one-third of patients following cardiac surgery, highlighting its common occurrence and clinical significance in the postoperative period.
New-onset postoperative atrial fibrillation (POAF) is already recognized as the most frequent complication after cardiac procedures, but much of the existing evidence has been derived from registries or single-centre experiences. To address this gap, William F. McIntyre and colleagues conducted a large prospective analysis within the VISION Cardiac Surgery cohort, aiming to provide a clearer understanding of POAF incidence, management strategies, and its association with longer-term outcomes.
The study included 12,234 adult patients undergoing cardiac surgery across 12 countries, providing a diverse, globally representative sample. More than half of the participants underwent isolated coronary artery bypass grafting. The study also examined outcomes between 30 days and one year after surgery.
The study led to the following findings:
- Within 30 days after surgery, 31.8% of patients developed postoperative atrial fibrillation, reaffirming its high frequency in the postoperative setting.
- At hospital discharge, 15.6% of POAF patients received anticoagulation alone.
- A majority of POAF patients (54.3%) were treated with antiplatelet therapy alone.
- Combination therapy with anticoagulants and antiplatelets was used in 23.9% of patients.
- A small proportion (6.3%) of patients received neither anticoagulation nor antiplatelet therapy.
- Nearly half of the patients with POAF were treated with amiodarone.
- Between 30 days and 1 year post-surgery, clinical atrial fibrillation occurred in 6.9% of patients with POAF compared to 0.6% without POAF.
- Patients with POAF had more than an eleven-fold higher risk of developing clinical AF during follow-up.
- The composite outcome of stroke or vascular death occurred in 2.3% of POAF patients versus 1.5% in those without POAF.
- The increased risk of stroke or vascular death did not reach statistical significance after adjustment.
- All-cause mortality was higher in POAF patients at 3.0% compared to 1.7% in those without POAF.
Overall, the findings highlight that POAF is not only common but also clinically relevant beyond the immediate postoperative phase. The variability in treatment patterns highlights the absence of a standardized management approach, while the increased risks of recurrent AF and mortality emphasize the need for vigilant follow-up and optimized care strategies.
These results provide important real-world evidence supporting closer monitoring and individualized management of patients who develop POAF after cardiac surgery.
Reference:
McIntyre, W. F., Devereaux, P. J., Belley-Cote, E. P., Spence, J. D., Zhao, R., Chan, M. T., Lomivorotov, V. V., Landoni, G., Paparella, D., Hillis, G. S., Mills, N. L., Parlow, J., Brady, K., Chen, S. M., Hayward, L., Healey, C., Ismaili, A., Louie, R., McEwen, C., . . . Whitlock, R. P. New-onset postoperative atrial fibrillation management and outcomes: The VISION Cardiac Surgery cohort. European Heart Journal. https://doi.org/10.1093/eurheartj/ehag236
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