Department of Cardiothoracic Surgery and Anesthesiology, Orebro University Hospital, S-701 85 Orebro, Sweden.
Eur J Cardiothorac Surg. 2010 Jun;37(6):1353-9. doi: 10.1016/j.ejcts.2009.12.033.
This article presents a study of postoperative atrial fibrillation (AF) and its long-term effects on mortality and heart rhythm.
The study cohort consisted of 571 patients with no history of AF who underwent primary aortocoronary bypass surgery from 1999 to 2000. Postoperative AF occurred in 165/571 patients (28.9%). After a median follow-up of 6 years, questionnaires were obtained from 91.6% of surviving patients and an electrocardiogram (ECG) from 88.6% of all patients. Data from hospitalisations due to arrhythmia or stroke during follow-up were analysed. The causes of death were obtained for deceased patients.
In postoperative AF patients, 25.4% had atrial fibrillation at follow-up compared with 3.6% of patients with no AF at surgery (p<0.001). An episode of postoperative AF was the strongest independent risk factor for development of late AF, with an adjusted risk ratio of 8.31 (95% confidence interval (CI) 4.20-16.43). Mortality was 29.7% (49 deaths/165 patients) in the AF group and 14.8% (60 deaths/406 patients) in the non-AF group (p<0.001). Death due to cerebral ischaemia was more common in the postoperative AF group (4.2% vs 0.2%, p<0.001), as was death due to myocardial infarction (6.7% vs 3.0%, p=0.041). Postoperative AF was an age-independent risk factor for late mortality, with an adjusted hazard ratio of 1.57 (95% CI 1.05-2.34).
Postoperative AF patients have an eightfold increased risk of developing AF in the future, and a doubled long-term cardiovascular mortality.
本文研究了术后心房颤动（AF）及其对死亡率和心律的长期影响。
研究队列包括 1999 年至 2000 年间进行首次主动脉冠状动脉旁路移植术且无 AF 病史的 571 例患者。571 例患者中有 165 例（28.9%）发生术后 AF。中位随访 6 年后，从存活患者中获得 91.6%的问卷调查，从所有患者中获得 88.6%的心电图（ECG）。分析随访期间因心律失常或中风住院的数据。对于已故患者，获得了死亡原因。
在术后 AF 患者中，25.4%在随访时出现房颤，而手术时无 AF 的患者为 3.6%（p<0.001）。术后 AF 发作是晚期 AF 发生的最强独立危险因素，调整后的风险比为 8.31（95%置信区间[CI] 4.20-16.43）。AF 组死亡率为 29.7%（49/165 例患者），无 AF 组为 14.8%（60/406 例患者）（p<0.001）。术后 AF 组因脑缺血而死亡的比例更高（4.2%比 0.2%，p<0.001），因心肌梗死而死亡的比例也更高（6.7%比 3.0%，p=0.041）。术后 AF 是晚期死亡率的独立危险因素，调整后的危险比为 1.57（95% CI 1.05-2.34）。
术后 AF 患者未来发生 AF 的风险增加 8 倍，长期心血管死亡率增加 2 倍。
