Atrial fibrillation after cardiac surgery: incidence, risk factors, and economic burden.
OBJECTIVE
To evaluate the incidence of postoperative atrial fibrillation (POAF), the predisposing factors, the results of treatment before discharge, and the impact on duration and costs of hospitalization.


METHODS
A prospective observational study.


METHODS
Patients who underwent cardiac surgery from January 1, 2007 to December 31, 2007.


METHODS
Electrocardiography was continuously monitored after surgery. Patients with symptomatic new-onset atrial fibrillation or lasting >15 minutes were treated with amiodarone and with DC shock in prolonged cases.


RESULTS
POAF occurred in 29.7%, with the higher incidence between the 1st and 4th postoperative day. Age (p < 0.001), atrial size >40 mm (p < 0.001), previous episodes of AF (p < 0.001), female sex (p = 0.010), and combined valve and bypass surgery (p = 0.012) were multivariate predictors of POAF at logistic regression. Sinus rhythm was restored by early treatment in 205 of 215 patients. This was associated with a low incidence of cerebrovascular events (<0.5%) and with a limited increase of average length of hospitalization (24 hours) in patients with POAF.


CONCLUSIONS
The overall incidence of POAF in the authors' center is close to 30%; 95.3% of patients were discharged in sinus rhythm. The increase in length and costs of hospitalization (on average, 1.0 day with a burden of about €1,800/patient) were significantly lower than in previous investigations.
Rostagno
Carlo
C
Department Critical Area, University of Florence, Florence, Italy. c.rostagno@katamail.com
La Meir
Mark
M
Gelsomino
Sandro
S
Ghilli
Lorenzo
L
Rossi
Alessandra
A
Carone
Enrico
E
Braconi
Lucio
L
Rosso
Gabriele
G
Puggelli
Francesco
F
Mattesini
Alessio
A
Stefàno
Pier Luigi
PL
Padeletti
Luigi
L
Maessen
Jos
J
Gensini
Gian Franco
GF
D000367:Age Factors; D000368:Aged; D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000191:economics*; D015984:Causality; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D004452:Echocardiography; D004599:Electric Stimulation Therapy; D004562:Electrocardiography; D023381:Endpoint Determination; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy; D012307:Risk Factors
D000889:Anti-Arrhythmia Agents; D000638:Amiodarone