Pillarisetti Jayasree, Patel Akshar, Bommana Sudharani, Guda Rajeshwer, Falbe Jillian, Zorn George Trip, Muehlebach Gregory, Vacek James, Lakkireddy Dhanunjaya
University of Kansas Hospital, Kansas City, KS, USA.
J Interv Card Electrophysiol. 2014 Jan;39(1):69-75. doi: 10.1007/s10840-013-9830-6. Epub 2013 Nov 29.
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.
The objective of this study was to assess the late recurrence and predictors of AF in patients undergoing open heart surgery.
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
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).
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.
虽然瓣膜手术和冠状动脉搭桥手术后早期出现的术后房颤是发病率和死亡率增加的常见原因，但这组患者中长期房颤的晚期复发情况尚未得到充分研究。
本研究的目的是评估接受心脏直视手术患者房颤的晚期复发情况及其预测因素。
从一个前瞻性心血管外科登记处选取了519例无房颤病史且在2000年5月至2004年4月期间接受心脏搭桥/瓣膜手术的心脏直视手术患者，随访至2009年5月。使用Cox比例风险模型在调整显著协变量后评估早期术后房颤对长期房颤的影响。
在这些患者中，25.6%（133例）出现早期（0 - 3个月）术后房颤（A组）。其余患者被视为对照组（B组，n = 386）。平均随访5 ± 1.9年后，房颤晚期发生率（3 - 84个月）为5.3%（n = 28）。A组房颤晚期发生率（复发性房颤）显著高于B组（11%对3%，n = 15对13，p = 0.0002）。在多变量分析中，早期术后房颤是房颤晚期复发的显著预测因素（风险比（HR）3.9，CI 1.8 - 8.4，p = 0.0003）。与B组相比，A组的死亡率也更高（21%对13%，n = 28对n = 51，p = 0.003），多变量分析显示早期术后房颤有死亡率更高的趋势（HR 1.7，p = 0.06）。
有早期术后房颤的患者房颤晚期复发率高于先前认为的，且有长期死亡率更高的趋势。术后房颤不应被视为良性疾病，应对这些患者进行密切随访。
