Ayoub Karam, Habash Fuad, Almomani Ahmed, Xu Jack, Marji Meera, Shaw-Devine Allison, Paydak Hakan, Vallurupalli Srikanth
Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR.
J Atr Fibrillation. 2018 Apr 30;10(6):1660. doi: 10.4022/jafib.1660. eCollection 2018 Apr.
New onset post-operative atrial fibrillation (POAF) can complicate both non-cardiac(NCS) and cardiac(CS) surgeries. Long term differences in recurrence of atrial fibrillation (AF) and incidence of ischemic stroke/transient ischemic attack(CVA)between these types of POAFare lacking.
To compare thelong term recurrence rate of AF and incidence of CVAin patients withnew onset POAF after CS and NCS.
All patients who developed POAF between May 2010 and April 2014 were included in this single-center, retrospective study Exclusion criteria included a prior history of atrial tachyarrhythmias and pre-operative use of anti-arrhythmic drugs. Recurrence of atrial fibrillation and CVA was identified by review of medical records, electrocardiogram and Holter monitor.
patients identified by the ICD9 code=523, 112 patients (61 cardiac; 51 non-cardiac) met inclusion criteria. Mean follow up was 943 days (range 32-2052 days).AF recurrence rate within 30 days after hospital discharge was higher in CS compared with NCS(10% vs 0%, p =0.03). Kaplan Meier analysis showed a trend towards higher recurrence in NCS compared with CS(HR 2.8; 95% CI 0.78-10.6, log rank p =0.03).In long term follow-up, CVA was numerically more common in patients with POAF after CS compared withNCS(10% vs 2%) though this difference was non-significant(HR 3.1; 95% CI 0.72-13.3; log rank p =0.26).
The risk of recurrent AF and ischemic stroke is not different between POAF after CS or NCS. The overall high rate of AF recurrence and risk of ischemic stroke mandate careful long term follow-up.
新发术后房颤（POAF）可使非心脏手术（NCS）和心脏手术（CS）均出现并发症。目前尚缺乏这两种类型POAF之间房颤（AF）复发及缺血性卒中/短暂性脑缺血发作（CVA）发生率的长期差异对比。
比较心脏手术和非心脏手术后新发POAF患者的AF长期复发率及CVA发生率。
本单中心回顾性研究纳入了2010年5月至2014年4月期间发生POAF的所有患者。排除标准包括既往有房性快速心律失常病史及术前使用抗心律失常药物。通过查阅病历、心电图和动态心电图监测来确定房颤和CVA的复发情况。
通过ICD9编码识别出患者，112例患者（61例心脏手术患者；51例非心脏手术患者）符合纳入标准。平均随访时间为943天（范围32 - 2052天）。心脏手术后出院30天内AF复发率高于非心脏手术（10%对0%，p = 0.03）。Kaplan Meier分析显示，非心脏手术患者AF复发趋势高于心脏手术患者（风险比2.8；95%置信区间0.78 - 10.6，对数秩检验p = 0.03）。在长期随访中，心脏手术后POAF患者CVA在数值上比非心脏手术患者更常见（10%对2%），尽管这种差异无统计学意义（风险比3.1；95%置信区间0.72 - 13.3；对数秩检验p = 0.26）。
心脏手术或非心脏手术后POAF患者AF复发和缺血性卒中风险无差异。AF总体高复发率及缺血性卒中风险要求进行仔细的长期随访。
