Management of Postoperative Atrial Fibrillation and Subsequent Outcomes in Contemporary Patients Undergoing Cardiac Surgery: Insights From the Society of Thoracic Surgeons CAPS‐Care Atrial Fibrillation Registry
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BACKGROUND: Postoperative 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. HYPOTHESIS: We hypothesize that treatment for POAF is variable, and that it is associated with particular morbidity and mortality following cardiac surgery. METHODS: We compared patient characteristics, operative procedures, postoperative management, and outcomes between patients with and without POAF following coronary artery bypass grafting (CABG) in the Society of Thoracic Surgeons multicenter Contemporary Analysis of Perioperative Cardiovascular Surgical Care (CAPS-Care) registry (2004-2005). RESULTS: Of 2390 patients who underwent CABG, 676 (28%) had POAF. Compared with patients without POAF, those with POAF were older (median age 74 vs 71 years, P<0.0001) and 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/1.73 m2, P=0.0001). A majority of patients with POAF were treated with amiodarone (77%) and β-blockers (68%); few (9.9%) underwent cardioversion. 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 (4.0% 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% confidence interval: 1.2-1.34, P<0.0001). CONCLUSIONS: Postoperative AF is common following CABG, and such patients continue to have higher rates of postoperative complications. Postoperative AF is significantly associated with increased length of stay following surgery.
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Postoperative AF is associated with increased length of hospital stay and higher rates of complications and mortality.
“and is associated with increased length of hospital stay and higher rates of complications and mortality.927”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [927]
Postoperative AF is associated with an increased early stroke risk, increased morbidity, and 30-day mortality.
“Postoperative AF is associated with an increased early stroke risk, increased morbidity, and 30-day mortality.927,951,952”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [927]
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The more you look, the more you find
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- Authors
- Steinberg, B. A., Zhao, Y., He, X., Hernandez, A. F., Fullerton, D. A., Thomas, K. L., Mills, R., Klaskala, W., Peterson, E. D., & Piccini, J. P.
- Affiliations
- Duke University (US)
- University of Colorado Denver (US)
- Janssen Research & Development (United States) (US)
- Duke Medical Center (US)
- Corresponding author
- Steinberg, Benjamin A.
- ORCID
- Venue
- Clinical Cardiology
- Publisher
- Wiley
- Published
- 2013-12-18
- Volume
- 37
- Issue
- 1
- Pages
- 7-13
- ISSN
- 0160-9289 (ISSN-L)
- 1932-8737
- PMC
- PMC3975246
- OpenAlex
- W1567937563
- Cited by
- 127
- References
- 26
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 6 · 2023: 13 · 2022: 11 · 2021: 17 · 2020: 19 · 2019: 15 · 2018: 12 · 2017: 10 · 2016: 6 · 2015: 5 · 2014: 1
- FWCI
- 2.72
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Cardiology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (5T32HL7101-37, T32HL007101)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Keywords
- postoperative atrial fibrillation, cardiac surgery, coronary artery bypass grafting, amiodarone, beta-blockers, cardioversion, postoperative complications, stroke, reoperation, length of hospital stay, in-hospital mortality, 30-day mortality, risk factors, acute limb ischemia
- MeSH terms
- Age Factors, Aged, Anti-Arrhythmia Agents, Coronary Artery Bypass, Atrial Fibrillation, Electric Countershock, Female, Glomerular Filtration Rate, Humans, Hypertension, Kidney, Kidney Diseases, Length of Stay, Male, Registries, Retrospective Studies, Risk Factors, Societies, Medical, Treatment Outcome, Hospital Mortality
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