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. 2024 Mar 4;7(3):e241537.
doi: 10.1001/jamanetworkopen.2024.1537.

Recurrence of Atrial Fibrillation in Patients With New-Onset Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting

Florian E M Herrmann  1   2   3 , Amar Taha  1   4 , Susanne J Nielsen  1   5 , Andreas Martinsson  1   4 , Emma C Hansson  1   5 , Gerd Juchem  2 , Anders Jeppsson  1   5
Affiliations

Recurrence of Atrial Fibrillation in Patients With New-Onset Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting

Florian E M Herrmann et al. JAMA Netw Open. .

Abstract

Importance: New-onset postoperative atrial fibrillation (POAF) occurs in approximately 30% of patients undergoing coronary artery bypass grafting (CABG). It is unknown whether early recurrence is associated with worse outcomes.

Objective: To test the hypothesis that early AF recurrence in patients with POAF after CABG is associated with worse outcomes.

Design, setting, and participants: This Swedish nationwide cohort study used prospectively collected data from the SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) registry and 3 other mandatory national registries. The study included patients who underwent isolated first-time CABG between January 1, 2007, and December 31, 2020, and developed POAF. Data analysis was performed between March 6 and September 16, 2023.

Exposure: Early AF recurrence defined as an episode of AF leading to hospital care within 3 months after discharge.

Main outcomes and measures: The primary outcome was all-cause mortality. Secondary outcomes included ischemic stroke, any thromboembolism, heart failure hospitalization, and major bleeding within 2 years after discharge. The groups were compared with multivariable Cox regression models, with early AF recurrence as a time-dependent covariate. The hypothesis tested was formulated after data collection.

Results: Of the 35 329 patients identified, 10 609 (30.0%) developed POAF after CABG and were included in this study. Their median age was 71 (IQR, 66-76) years. The median follow-up was 7.1 (IQR, 2.9-9.0) years, and most patients (81.6%) were men. Early AF recurrence occurred in 6.7% of patients. Event rates (95% CIs) per 100 patient-years with vs without early AF recurrence were 2.21 (1.49-3.24) vs 2.03 (1.83-2.25) for all-cause mortality, 3.94 (2.92-5.28) vs 2.79 (2.56-3.05) for heart failure hospitalization, and 3.97 (2.95-5.30) vs 2.74 (2.51-2.99) for major bleeding. No association between early AF recurrence and all-cause mortality was observed (adjusted hazard ratio [AHR], 1.17 [95% CI, 0.80-1.74]; P = .41). In exploratory analyses, there was an association with heart failure hospitalization (AHR, 1.80 [95% CI, 1.32-2.45]; P = .001) and major bleeding (AHR, 1.92 [1.42-2.61]; P < .001).

Conclusions and relevance: In this cohort study of early AF recurrence after POAF in patients who underwent CABG, no association was found between early AF recurrence and all-cause mortality. Exploratory analyses showed associations between AF recurrence and heart failure hospitalization, oral anticoagulation, and major bleeding.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Taha reported serving as a medical advisor to and receiving personal fees from Medtronic and receiving lecture fees from Abbott outside the submitted work. Dr Hansson reported receiving personal fees from Pfizer outside the submitted work. Dr Jeppsson reported receiving grants from AstraZeneca and personal fees from AstraZeneca, LFB Biotechnologies, Werfen, Novo Nordisk, and Bayer outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flowchart of Population Selection
AF indicates atrial fibrillation; CABG, coronary artery bypass grafting; POAF, new-onset postoperative atrial fibrillation.
Figure 2.
Figure 2.. Atrial Fibrillation (AF) Recurrence Within 24 Months of Discharge in Patients With Postoperative Atrial Fibrillation (POAF) After Coronary Artery Bypass Grafting (CABG)
Cumulative incidence of AF recurrence, adjusted for the competing risk of death, within 24 months of discharge in patients with new-onset POAF after CABG. Shaded area indicates 95% CIs.
Figure 3.
Figure 3.. Atrial Fibrillation (AF) Recurrence Within 14 Years of Discharge in Patients With Postoperative Atrial Fibrillation (POAF) After Coronary Artery Bypass Grafting (CABG)
Cumulative incidence of AF recurrence, adjusted for the competing risk of death, within 14 years of discharge in patients with new-onset POAF after CABG. Shaded area indicates 95% CIs.
See this image and copyright information in PMC

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