title: Late postoperative atrial fibrillation after cardiac surgery: a national survey within the cardiac rehabilitation setting.
abstract: OBJECTIVE
  The aims of this study were to determine the incidence and clinical predictors of new-onset and recurrent late postoperative atrial fibrillation (POPAF) in a large cohort of patients who underwent cardiac rehabilitation programs (CRPs) after discharge from surgery units, and the association between late POPAF and cardiovascular morbidity and mortality in the medium term.
  
  
  METHODS
  The ISYDE and ICAROS registries were two multicenter, prospective studies carried out by the Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiology (IACPR-GICR), providing clinical information on consecutive patients completing CRP in 165 facilities. Patients following cardiac surgery were considered, with the exclusion of those with persistent POPAF at discharge from the surgery units. A total of 2256 patients following cardiac surgery were enrolled (isolated coronary surgery 62.9%, valve interventions 16%, combined surgery 21.1%).
  
  
  RESULTS
  The mean age of patients was 67 ± 10 years, and the observation period 13 ± 20 days. During CRP, POPAF occurred in 241 (10.7%) patients, with 4.4% new-onset and 6.3% recurrent cases, respectively. In the logistic regression model, valve surgery (P < 0.05), a history of early POPAF (P < 0.001), and the presence of postoperative ventricular arrhythmias (P < 0.05) independently predicted the occurrence of late POPAF. Lack of prescription of cardioprotective drugs was not associated with late POPAF. Late POPAF increased the 1-year risk of cardiovascular events after CRP, mainly episodes of decompensated heart failure.
  
  
  CONCLUSIONS
  A high level of suspicion for late POPAF, after discharge from surgery units, should be maintained due to the risk of occurrence, the low antiarrhythmic effect of common cardioprotective drugs and the impact on cardiovascular prognosis.
authors.affiliation: Cardiovascular Rehabilitation Unit, Le Terrazze Clinic, Cunardo, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Ambrosetti
authors.forename: Roberto
authors.initials: R
authors.lastname: Tramarin
authors.forename: Raffaele
authors.initials: R
authors.lastname: Griffo
authors.forename: Stefania
authors.initials: S
authors.lastname: De Feo
authors.forename: Francesco
authors.initials: F
authors.lastname: Fattirolli
authors.forename: Annarita
authors.initials: A
authors.lastname: Vestri
authors.forename: Carmine
authors.initials: C
authors.lastname: Riccio
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Temporelli
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology*; D000072038:Cardiac Rehabilitation; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors