New-onset of postoperative atrial fibrillation is likely to recur in the absence of other triggers

Jesper Park-Hansen,1 Anders M Greve,2,3 Johan Clausen,1 Susanne J Holme,4 Christian L Carranza,4 Akhmadjon Irmukhamedov,5 Lubna Sabah,1 Qing Lin,1 Anne Sofie Madsen,1 Helena Domínguez1,2 1Department of Cardiology, Bispebjerg/Frederiksberg University Hospital, Copenhagen, Denmark; 2Department of Biomedicine, Faculty of Health and Medical Sciences, 3Department of Cardiology, Herlev/Gentofte University Hospital, Copenhagen, Denmark; 4Department of Thoracic Surgery, Rigshospitalet, Copenhagen, Denmark; 5Department of Thoracic Surgery, Odense University Hospital, Odense, Denmark Background: Incident atrial fibrillation (AF) is reported in 10%–65% of patients without previous AF diagnosis after open heart surgery. The risk of late AF recurrence after a postoperative AF onset is unclear, and it is controversial whether AF limited to the postoperative period should elicit oral anticoagulation (OAC) therapy. The primary objective of this study was to evaluate the long-term recurrence of AF in patients developing new-onset peri-procedural AF. Patients and methods: Patients (n=189) with available baseline and follow-up data included in Left Atrial Appendage Closure with Surgery trial were coded for known AF at baseline and for postoperative first-time AF diagnosis. AF occurrence was classified as follows: peri-procedural ≤7 days postoperatively, early >7 days but ≤3 months and late >3 months. Patients with no AF recurrence registered during follow-up were invited to undergo Holter monitoring. Results: A total of 163 (86.2%) patients had no history of AF. Among these, 80 (49.1%) developed new-onset peri-procedural AF. After a mean follow-up of 3.7±1.6 years, late AF occurred in 35 of the 80 (43.8%) patients who developed peri-procedural AF and in 6 additional patients (7.2%) who remained in sinus rhythm until discharge (hazard ratio [HR] 9.3, 95% CI 3.8–22.4, p<0.001). Patients with peri-procedural AF and early AF had 12.24 times higher risk of late AF (95% CI 4.76–31.45, p<0.001) as compared to the group with no postoperative AF. Conclusion: New-onset of AF after open heart surgery has a high rate of recurrence and should not be regarded as a self-limiting phenomenon secondary to surgery. Keywords: atrial fibrillation, postoperative atrial fibrillation, heart surger