Postoperative atrial fibrillation is associated with late mortality after coronary surgery, but not after valvular surgery.
BACKGROUND
Numerous studies have attempted to determine the etiology and prophylactic measures concerning atrial fibrillation (AF) after cardiac surgery. However, limited data are available analyzing the association between postoperative AF and late mortality. We sought to determine if AF after cardiac surgery affects postoperative survival.


METHODS
All cardiac surgery patients (n = 9,495) undergoing cardiac surgery between January 1994 and December 2004 were studied. The study population comprised coronary artery bypass graft surgery (CABG [n = 7,621]), valvular surgeries (n = 995), and their combination (n = 879). Patients affected by postoperative AF were identified, and long-term survival was obtained from Swedish population registry and evaluated using Cox proportional hazards methods to adjust for baseline differences.


RESULTS
The overall AF incidence was 26.7%, subdivided into 22.9%, 39.8%, and 45.2% for CABG, valve surgery, and combined procedures, respectively. The median follow-up for the entire study population was 7.9 years (maximum, 13.4). Postoperative AF independently affected long-term survival in CABG patients (hazard ratio 1.22; 95% confidence interval: 1.08 to 1.37). For isolated valvular surgery or combined procedures, AF was not significantly associated with long-term survival (hazard ratio 1.21, 95% confidence interval: 0.92 to 1.58; and hazard ratio 1.15, 95% confidence interval: 0.90 to 1.46, respectively).


CONCLUSIONS
Postoperative AF increases late mortality after isolated CABG surgery only. This finding was not statistically confirmed after isolated or combined valvular procedures. Our results draw the attention to possible AF recurrence after hospital discharge, indicating a strict postoperative surveillance.
Mariscalco
Giovanni
G
Department of Surgical Sciences, Cardiac Surgery Unit, Varese University Hospital, Varese, Italy. giovannimariscalco@yahoo.it
Engström
Karl Gunnar
KG
D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D002423:Cause of Death / Q000639:trends; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors