title: Management of New-Onset Postoperative Atrial Fibrillation Utilizing Insertable Cardiac Monitor Technology to Observe Recurrence of AF (MONITOR-AF).
abstract: BACKGROUND
  New-onset postoperative atrial fibrillation (POAF) occurs in up to 30% of patients undergoing coronary artery bypass grafting (CABG). POAF is associated with short- and long-term mortality.
  
  
  METHODS
  To identify the true incidence and time course of recurrent atrial fibrillation (AF) in patients with POAF, we prospectively assigned 23 patients with POAF to receive an implantable loop recorder (ILR; Medtronic Inc., Minneapolis, MN, USA) for the detection of recurrent AF. Two electrophysiologists independently adjudicated monthly ILR transmissions to classify recurrent AF. We defined AF as any episode lasting ≥6 minutes.
  
  
  RESULTS
  The cohort included 23 subjects averaging 69.1 ± 7.2 years of age. Their mean CHADS2score averaged 1.9 ± 0.8. Note that 26.1% underwent direct current cardioversion prior to discharge; 95.7% left the hospital taking amiodarone and 26.1% warfarin. A total of 14 patients (60.9%) experienced recurrent AF. AF first recurred within 3 months in nine patients (39.1%), and in 10 patients AF emerged or continued beyond 3 months. Eight of 17 (47.1%) patients followed for at least 1 year experienced AF recurrence beyond 1 year of CABG. The time from surgery to first AF episode averaged 143 ± 22.5 days. Long-term monitoring shows that 60.9% of patients with POAF develop recurrent AF.
  
  
  CONCLUSIONS
  POAF may represent a propensity for recurrent paroxysmal atrial fibrillation, and not simply a transient consequence of postoperative stress and inflammation. Better detection of recurrent AF might identify patients at risk for stroke who would benefit from continuing anticoagulation.
authors: Division of Cardiology, Section of Electrophysiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia. melcham@emory.edu.
authors: Mikhael F
authors: MF
authors: El-Chami
authors: Division of Cardiology, Section of Electrophysiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors: Faisal M
authors: FM
authors: Merchant
authors: Division of Cardiology, Section of Electrophysiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors: Paige
authors: P
authors: Smith
authors: Division of Cardiology, Section of Electrophysiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors: Mathew
authors: M
authors: Levy
authors: Division of Cardiology, Section of Electrophysiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors: Angela Gill
authors: AG
authors: Nelms
authors: Division of Cardiology, Section of Electrophysiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors: John
authors: J
authors: Merlino
authors: Division of Cardiothoracic Surgery, Mount Sinai University, New York, New York.
authors: John
authors: J
authors: Puskas
authors: Division of Cardiology, Section of Electrophysiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors: Angel R
authors: AR
authors: Leon
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis*; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic; D011183:Postoperative Complications / Q000175:diagnosis*; D011446:Prospective Studies; D012008:Recurrence
keywords: atrial fibrillation; coronary artery bypass; implantable loop recorder; postoperative atrial fibrillation