Abstract
Background: Atrial fibrillation (AF) after cardiac surgery increases patient morbidity, and occurs in approximately one third of the patients after coronary artery bypass surgery. In patients with congenital heart disease (CHD) prevalence, determinants and burden of post-operative AF are unknown. Tailored treatment of high risk patients might reduce in-hospital morbidity and risk of death.
Methods: Adults with CHD operated between January 2001 and January 2011 in the Academic Medical Center in Amsterdam were studied. Patients with in-hospital AF were identified by careful review of the medical charts. In-hospital AF was defined as documented AF on the intensive care unit and / or on the surgery ward during hospitalization.
Results: Data of 412 consecutive CHD patients (median age 36 (range 18 - 74) years, 56% male) were studied. Forty-five patients (10.9%) had a history of AF (26 paroxysmal, 16 persistent and 3 permanent) pre-operatively. During post-operative hospitalization 54 (13.1%) patients had AF (43 paroxysmal and 11 persistent). In multivariate regression age>40 years, a history of paroxysmal or persistent AF, and cardiopulmonary bypass time exceeding 150 minutes were found significant determinants of post-operative in-hospital AF. Interestingly, a significant OR of less than one was found for patients who underwent prior cardiac surgery, suggestive that prior cardiac surgery was protective for post-operative AF. Post-operative AF was associated with prolonged intensive care unit stay (in hours, β = 0.12; p = 0.01), congestive heart failure (OR = 5.4; p < 0.01) and use of inotropes (OR = 2.8; p < 0.01). Twenty patients had recurrence of AF during a median follow up of 3.1 years (range 0 - 118 months). A trend towards higher mortality rate was observed in patients with in-hospital AF post-operatively as compared to patients without AF (92% vs. 97%), p = 0.087).
Conclusion: Post-operative AF occurs in 13% of patients with CHD and is associated with worse in-hospital outcome. Its prevalence is lower than in patients undergoing standard cardiac surgery. A tailored approach in CHD patients older than 40 years, with a history of pre-operative AF and with cardiopulmonary bypass times exceeding 150 minutes might be considered.
Methods: Adults with CHD operated between January 2001 and January 2011 in the Academic Medical Center in Amsterdam were studied. Patients with in-hospital AF were identified by careful review of the medical charts. In-hospital AF was defined as documented AF on the intensive care unit and / or on the surgery ward during hospitalization.
Results: Data of 412 consecutive CHD patients (median age 36 (range 18 - 74) years, 56% male) were studied. Forty-five patients (10.9%) had a history of AF (26 paroxysmal, 16 persistent and 3 permanent) pre-operatively. During post-operative hospitalization 54 (13.1%) patients had AF (43 paroxysmal and 11 persistent). In multivariate regression age>40 years, a history of paroxysmal or persistent AF, and cardiopulmonary bypass time exceeding 150 minutes were found significant determinants of post-operative in-hospital AF. Interestingly, a significant OR of less than one was found for patients who underwent prior cardiac surgery, suggestive that prior cardiac surgery was protective for post-operative AF. Post-operative AF was associated with prolonged intensive care unit stay (in hours, β = 0.12; p = 0.01), congestive heart failure (OR = 5.4; p < 0.01) and use of inotropes (OR = 2.8; p < 0.01). Twenty patients had recurrence of AF during a median follow up of 3.1 years (range 0 - 118 months). A trend towards higher mortality rate was observed in patients with in-hospital AF post-operatively as compared to patients without AF (92% vs. 97%), p = 0.087).
Conclusion: Post-operative AF occurs in 13% of patients with CHD and is associated with worse in-hospital outcome. Its prevalence is lower than in patients undergoing standard cardiac surgery. A tailored approach in CHD patients older than 40 years, with a history of pre-operative AF and with cardiopulmonary bypass times exceeding 150 minutes might be considered.
| Original language | English |
|---|---|
| Article number | A11388 |
| Journal | Circulation |
| Volume | 126 |
| DOIs | |
| Publication status | Published - 2012 |
| Externally published | Yes |