Background
Post-operative atrial fibrillation (POAF) is a well-recognized complication of cardiac surgery, however, its management remains a challenge and the implementation and outcomes of various strategies in clinical practice remain unclear.
Methods
We compared patient characteristics, operative procedures, post-operative management, and outcomes between patients with and without POAF following coronary artery bypass grafting (CABG) in the Society for Thoracic Surgery multicenter CAPS-Care registry (2004–2005).
Results
Of 2,390 patients who underwent CABG, 676 (28%) had POAF. Compared with patients without POAF, those with POAF were older (median age 74 vs. 71, p<0.0001), more likely to have hypertension (86% vs. 83%, p=0.04), and impaired renal function (median estimated glomerular filtration rate, 56.9 vs. 58.6 mL/min/1.73m2, p=0.0001). A majority of patients with POAF were treated with amiodarone (77%) and beta-blockers (68%); few underwent cardioversion (9.9%). Patients with POAF were more likely to experience complications (57% vs.41%, p<0.0001), including acute limb ischemia (1.0% vs. 0.4%, p=0.03), stroke (4% vs. 1.9%, p=0.002), and reoperation (13% vs. 7.9%, p<0.0001). Length of stay (median 8 days vs. 6 days, p<0.0001), in-hospital mortality (6.8% vs. 3.7%, p=0.001), and 30-day mortality (7.8 vs. 3.9, p<0.0001) were all worse for patients with POAF. In adjusted analyses, POAF remained associated with increased length of stay following surgery (adjusted ratio of the mean 1.27, 95% CI 1.2–1.34, p<0.0001).
Conclusions
In conclusion, post-operative AF is common following CABG, and such patients continue to have higher rates of post-operative complications. Post-operative AF is significantly associated with increased length of stay following surgery.
