Pre- and postoperative atrial fibrillation in CABG patients have similar prognostic impact.
OBJECTIVE
To study pre- and postoperative atrial fibrillation and its long-term effects in a cohort of aortocoronary bypass surgery patients.


METHODS
Altogether 615 patients undergoing aortocoronary bypass graft surgery in 1999-2000 were studied. Forty-four (7%) had preoperative atrial fibrillation. Postoperative atrial fibrillation occurred in 165/615 patients (27%) while 406/615 patients (66%) had no atrial fibrillation. After a median follow-up of 15 years, symptoms and medication in survivors were recorded, and cause of death in the deceased was obtained.


RESULTS
Death due to cerebral ischaemia was most common in the pre- and postoperative atrial fibrillation groups (7% and 5%, respectively, v. 2% among those without atrial fibrillation, p = .038), as were death due to heart failure (18% and 14%, v. 7%, p = .007) and sudden death (9% and 5%, v. 2%, p = .029). The presence of pre- or postoperative atrial fibrillation was an independent risk factor for late mortality (hazard ratios 1.47 (1.02-2.12) and 1.28 (1.01-1.63), respectively).


CONCLUSIONS
Patients with pre- or postoperative atrial fibrillation undergoing aortocoronary bypass surgery have increased long-term mortality and risk of cerebral ischemic and cardiovascular death compared with patients in sinus rhythm.
a Department of Cardiology and Cardiothoracic Surgery , School of Health and Medical Sciences, Örebro University Hospital , Örebro , Sweden.
Espen
E
Fengsrud
b Department of Clinical Sciences , South Hospital, Arrhythmia Center, Karolinska Institute , Stockholm , Sweden.
Anders
A
Englund
a Department of Cardiology and Cardiothoracic Surgery , School of Health and Medical Sciences, Örebro University Hospital , Örebro , Sweden.
Anders
A
Ahlsson
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D002545:Brain Ischemia / Q000401:mortality; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002423:Cause of Death; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
D000925:Anticoagulants
Atrial fibrillation; anticoagulation; bypass surgery; cerebral ischaemia; survival