title: Atrial fibrillation following open heart surgery: long-term incidence and prognosis.
abstract: BACKGROUND
  While early postoperative atrial fibrillation (post op AF) following valve and coronary artery bypass surgery is a known common cause of increased morbidity and mortality, the late recurrence of AF long term in this group of patients has not been well studied.
  
  
  OBJECTIVE
  The objective of this study was to assess the late recurrence and predictors of AF in patients undergoing open heart surgery.
  
  
  METHODS
  From a prospective cardiovascular surgery registry, 519 patients with no prior history of AF who underwent open heart surgery for cardiac bypass/valvular surgeries between May 2000 and April 2004 were followed until May 2009. A Cox proportional hazards model was used to assess the impact of early post op AF on the long-term AF after adjusting for significant covariates
  
  
  RESULTS
  Of these patients, 25.6 % (133) had early (0-3 months) post op AF (group A). The remainder of patients were considered as controls (group B, n = 386). Late occurrence of AF (3-84 months) was 5.3 % (n = 28) after a mean follow up duration of 5 ± 1.9 years. The late occurrence of AF in group A (recurrent AF) was significantly higher than in group B (11 vs 3 % n = 15 vs 13, p = 0.0002). Early postoperative AF was a significant predictor of late recurrence of AF in multivariate analysis (hazard ratio (HR) 3.9, CI 1.8-8.4, p = 0.0003). Group A also had higher mortality compared to group B (21 vs 13 %, n = 28 vs n = 51, p = 0.003) with early postoperative AF showing a trend towards higher mortality on multivariate analysis (HR 1.7, p = 0.06).
  
  
  CONCLUSIONS
  Late recurrence of AF is higher than was previously thought to be in patients experiencing early post operative AF with a trend towards higher long-term mortality. Post op AF should not be dismissed as a benign entity and these patients should be followed closely.
authors.affiliation: University of Kansas Hospital, Kansas City, KS, USA.
authors.forename: Jayasree
authors.initials: J
authors.lastname: Pillarisetti
authors.forename: Akshar
authors.initials: A
authors.lastname: Patel
authors.forename: Sudharani
authors.initials: S
authors.lastname: Bommana
authors.forename: Rajeshwer
authors.initials: R
authors.lastname: Guda
authors.forename: Jillian
authors.initials: J
authors.lastname: Falbe
authors.forename: George Trip
authors.initials: GT
authors.lastname: Zorn
authors.forename: Gregory
authors.initials: G
authors.lastname: Muehlebach
authors.forename: James
authors.initials: J
authors.lastname: Vacek
authors.lastname: Sue Min Lai
authors.forename: Dhanunjaya
authors.initials: D
authors.lastname: Lakkireddy
mesh_terms: D001281:Atrial Fibrillation / Q000401:mortality*; D058385:Cardiac Valve Annuloplasty / Q000401:mortality*; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D007615:Kansas / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome