Characterization of post-discharge atrial fibrillation following open-heart surgery in uncomplicated patients referred to an early rehabilitation program.
BACKGROUND
Atrial fibrillation (AF) is frequently observed after open-heart surgery, following discharge from the cardiac surgery clinic. Compared to those usually reported in the early postoperative period, this arrhythmia is delayed in onset and is often a cause of re-hospitalization. Post-discharge AF has never been characterized in the literature.


METHODS
We retrospectively analyzed post-discharge AF occurring within 30 days of coronary artery bypass graft or of valvular procedures in 376 patients referred to an early postoperative rehabilitation program. To investigate the probability of the persistence of post-discharge AF, we prospectively examined 232 patients who had undergone valvular procedures.


RESULTS
An arrhythmia was recognized in 61/376 patients (16%), resulted in worsening of the NYHA functional class in 27 (44%) and in life-threatening hemodynamic effects requiring urgent cardioversion in 5 (8%). Events were predicted by the occurrence of postoperative AF (6-fold higher risk), left ventricular hypertrophy, an enlarged left atrium and valvular pathology (3-fold) and by the lack of beta-blocker protection (5-fold). AF persisted in 20/232 (9% of the study population, 18% of patients who had post-discharge AF) and had a relevant impact on the patient's clinical status. Predictors of events were older age, an enlarged left atrium and a lower left ventricular ejection fraction.


CONCLUSIONS
Post-discharge AF following open-heart surgery is frequent in patients undergoing valvular procedures and often persists over time. The clinical impact of the arrhythmia is relevant, it might cause re-hospitalizations in many circumstances and, consequently, may have an impact on hospital resources. Events are much less frequent in patients taking beta-blockers than in those who do not, and they can be predicted by simple variables observed in the early stages after surgery.
Cioffi
G
G
Department of Cardiology, Villa Bianca Hospital, Trento, Italy. gcioffi@albaclick.com
Mureddu
G
G
Cemin
C
C
Russo
T E
TE
Pellegrini
A
A
Terrasi
F
F
Stefenelli
C
C
de Simone
G
G
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000534:rehabilitation; D015984:Causality; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011183:Postoperative Complications / Q000188:drug therapy / Q000517:prevention & control; D015995:Prevalence; D011446:Prospective Studies; D012044:Regression Analysis; D012189:Retrospective Studies; D013997:Time Factors
D000319:Adrenergic beta-Antagonists