Prognosis of transient new-onset atrial fibrillation during vascular surgery.
BACKGROUND
Chronic atrial fibrillation (AF) in a non-surgical setting is associated with cardiovascular events. However, the prognosis of transient new-onset AF during vascular surgery is unknown.


OBJECTIVE
The purpose of this study is to investigate the prognosis of new-onset AF during vascular surgery using continuous electrocardiographic monitoring (continuous-ECG).


METHODS
In this study, 317 patients, all in sinus rhythm, scheduled for major vascular surgery were screened for cardiac risk factors. Continuous-ECG recordings for 72h and standard ECG on days 3, 7 and 30 were used to identify new-onset AF. Cardiac troponin T (cTnT) was measured routinely after surgery. Study endpoint was a composite of cardiac death, myocardial infarction, unstable angina and stroke (cardiovascular events) at 30 days after surgery and during late follow-up. Median follow-up was 12 (interquartile range 2-28) months.


RESULTS
New-onset AF was noted in 15 (4.7%) patients. All but three patients returned spontaneously to sinus rhythm. The composite endpoint of cardiovascular events within 30 days and during late follow-up occurred in 34 (11%) and 62 (20%) patients, respectively. Multivariate regression analysis showed that new-onset AF was associated with perioperative (hazard ratio (HR) 6.0; 95% CI: 2.4-15) and late cardiovascular events (HR 4.2, 95% CI: 2.1-8.8).


CONCLUSIONS
New-onset AF during vascular surgery is associated with an increased incidence of 30-day and late cardiovascular events.
Winkel
T A
TA
Department of Vascular Surgery, Erasmus MC, 's Gravendijkwal 230, Rotterdam, The Netherlands.
Schouten
O
O
Hoeks
S E
SE
Verhagen
H J M
HJ
Bax
J J
JJ
Poldermans
D
D
D000368:Aged; D000789:Angina, Unstable / Q000209:etiology; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D015716:Electrocardiography, Ambulatory; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009203:Myocardial Infarction / Q000209:etiology; D011379:Prognosis; D016016:Proportional Hazards Models; D012075:Remission, Spontaneous; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D020107:Troponin T / Q000097:blood
D015415:Biomarkers; D020107:Troponin T