Postoperative atrial fibrillation in patients undergoing aortocoronary bypass surgery carries an eightfold risk of future atrial fibrillation and a doubled cardiovascular mortality
Abstract
OBJECTIVE: This article presents a study of postoperative atrial fibrillation (AF) and its long-term effects on mortality and heart rhythm. METHODS: The study cohort consisted of 571 patients with no history of AF who underwent primary aortocoronary bypass surgery from 1999 to 2000. Postoperative AF occurred in 165/571 patients (28.9%). After a median follow-up of 6 years, questionnaires were obtained from 91.6% of surviving patients and an electrocardiogram (ECG) from 88.6% of all patients. Data from hospitalisations due to arrhythmia or stroke during follow-up were analysed. The causes of death were obtained for deceased patients. RESULTS: In postoperative AF patients, 25.4% had atrial fibrillation at follow-up compared with 3.6% of patients with no AF at surgery (p<0.001). An episode of postoperative AF was the strongest independent risk factor for development of late AF, with an adjusted risk ratio of 8.31 (95% confidence interval (CI) 4.20-16.43). Mortality was 29.7% (49 deaths/165 patients) in the AF group and 14.8% (60 deaths/406 patients) in the non-AF group (p<0.001). Death due to cerebral ischaemia was more common in the postoperative AF group (4.2% vs 0.2%, p<0.001), as was death due to myocardial infarction (6.7% vs 3.0%, p=0.041). Postoperative AF was an age-independent risk factor for late mortality, with an adjusted hazard ratio of 1.57 (95% CI 1.05-2.34). CONCLUSIONS: Postoperative AF patients have an eightfold increased risk of developing AF in the future, and a doubled long-term cardiovascular mortality.
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In the long term, patients with an episode of postoperative AF have a twofold increase in cardiovascular mortality and a substantially increased risk of future AF and ischaemic stroke compared with patients that remain in sinus rhythm after surgery.
“In the long term, patients with an episode of postoperative AF have a twofold increase in cardiovascular mortality and a substantially increased risk of future AF and ischaemic stroke compared with patients that remain in sinus rhythm after surgery.952-958”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [955]
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- Authors
- Ahlsson, A., Fengsrud, E., Bodin, L., & Englund, A.
- Affiliations
- Örebro University Hospital (SE)
- Corresponding author
- Ahlsson, Anders
- Venue
- European Journal of Cardio-Thoracic Surgery
- Publisher
- Oxford University Press (OUP)
- Published
- 2010-06
- Volume
- 37
- Issue
- 6
- Pages
- 1353-1359
- ISSN
- 1010-7940 (ISSN-L)
- OpenAlex
- W2144902508
- Cited by
- 259
- References
- 24
- Citations by year
- 2026: 11 · 2025: 22 · 2024: 28 · 2023: 17 · 2022: 26 · 2021: 22 · 2020: 27 · 2019: 21 · 2018: 15 · 2017: 17 · 2016: 9 · 2015: 9 · 2014: 15 · 2013: 9 · 2012: 7
- FWCI
- 4.39
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Cardio-Thoracic Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- postoperative atrial fibrillation, coronary artery bypass grafting, cardiovascular mortality, stroke, myocardial infarction, risk factors, cardiac arrhythmias
- MeSH terms
- Aged, Coronary Artery Bypass, Atrial Fibrillation, Brain Ischemia, Electrocardiography, Epidemiologic Methods, Female, Humans, Male, Middle Aged, Myocardial Infarction, Prognosis, Recurrence, Stroke
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