Sandgren Emma, Wickbom Anders, Kalm Torbjörn, Ahlsson Anders, Edvardsson Nils, Engdahl Johan
Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden.
Department of Medicine, Halland Hospital Varberg, Varberg, Sweden.
Heart Rhythm O2. 2021 May 11;2(3):247-254. doi: 10.1016/j.hroo.2021.05.001. eCollection 2021 Jun.
Atrial fibrillation (AF) is common after coronary artery bypass graft (CABG) surgery.
To evaluate the incidence and recurrence rate of AF during 1 year after CABG surgery. We also aimed at calculating the AF burden and compare long-term intermittent vs continuous electrocardiogram (ECG) monitoring.
Forty patients scheduled for CABG surgery were equipped with an implantable loop recorder (ILR). After discharge, they carried out handheld ECG 3 times daily during the first 30 postoperative days and during 2 weeks at 3 and 12 months. During hospital stay they were monitored with telemetry.
Altogether 27 of 40 (68%) patients were diagnosed with AF, 24 during the first month (21 in-hospital and 3 after discharge) and 3 during months 2-12. Three patients progressed into persistent AF. In addition, 17 patients had AF recurrence, 9 of them after the first 30 days. In patients with paroxysmal AF, the AF burden was low, 0.1% (interquartile range [IQR] 0.02%-0.3%). Patients with AF had higher CHADS-VASc scores than non-AF patients: median 4 (IQR 3-4) and 3 (IQR 2-3.5), respectively, = .006. The handheld ECG identified 45% (9/20) of the patients with AF episodes identified with continuous ECG monitoring with the ILR after discharge from hospital, = .001.
Patients with AF during the postoperative hospitalization showed a high likelihood of recurrent AF, usually within 30 days. Continuous ECG monitoring with an ILR was superior to the handheld ECG for detecting patients with AF. The AF burden was low.
冠状动脉旁路移植术（CABG）后房颤（AF）很常见。
评估CABG术后1年内房颤的发生率和复发率。我们还旨在计算房颤负荷，并比较长期间歇性与持续性心电图（ECG）监测。
40例计划行CABG手术的患者配备了植入式环路记录仪（ILR）。出院后，他们在术后的前30天内每天进行3次手持式心电图检查，并在3个月和12个月时的2周内进行检查。住院期间通过遥测进行监测。
40例患者中有27例（68%）被诊断为房颤，24例在第一个月（21例住院期间和3例出院后），3例在第2 - 12个月。3例患者进展为持续性房颤。此外，17例患者房颤复发，其中9例在最初30天后复发。阵发性房颤患者的房颤负荷较低，为0.1%（四分位间距[IQR] 0.02% - 0.3%）。房颤患者的CHADS - VASc评分高于非房颤患者：中位数分别为4（IQR 3 - 4）和3（IQR 2 - 3.5），P = 0.006。手持式心电图检查发现，出院后通过ILR进行连续心电图监测确诊为房颤发作的患者中有45%（9/20），P = 0.001。
术后住院期间发生房颤的患者房颤复发可能性很高，通常在30天内。使用ILR进行连续心电图监测在检测房颤患者方面优于手持式心电图。房颤负荷较低。
