Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.
Department of Anesthesiology, Weill Cornell Medicine, New York, New York.
Ann Thorac Surg. 2023 Sep;116(3):615-622. doi: 10.1016/j.athoracsur.2022.11.007. Epub 2022 Nov 11.
Postoperative atrial fibrillation (POAF) is a frequent complication of cardiac surgery. However, only a few detailed descriptions of the arrhythmia have been reported. We aim to describe the characteristics, outcomes, and variables associated with POAF and to evaluate how posterior pericardiotomy (PP) affects POAF characteristics.
In this post hoc analysis of the Posterior left pericardiotomy for the prevention of AtriaL fibrillation After Cardiac Surgery (PALACS) trial, we describe POAF characteristics based on continuous in-hospital telemetry data.
Of 420 patients, 103 (24.5%) developed POAF. Median time to onset was 50.3 hours; 70.9% of events occurred within 3 days. Hemodynamic instability and rapid ventricular response occurred in 8.7% and 51.5% of cases, respectively. Most POAF patients received antiarrhythmics (97.1%), 22.3% electrical cardioversion, and 40.8% systemic anticoagulation. Median POAF duration was 24.0 hours; 70.9% of cases resolved within 36 hours. Median POAF burden was 15.9%. All patients were in sinus rhythm at follow-up. POAF was associated with longer hospitalization (7 vs 6 days; P < .001), but not increased mortality or morbidity. PP reduced POAF incidence (17.7% vs 31.3%; P = .001), especially after postoperative day 2 (time to POAF onset 41.9 vs 57.1 hours; P = .01). Age was associated with POAF. Female sex, coronary artery bypass grafting, beta blockers, and PP were inversely associated.
POAF remains frequent after cardiac surgery. Hemodynamic instability is rare, although rapid ventricular response and need for electrical cardioversion are frequent. POAF burden is significant, and the arrhythmias resolve within 30 days. PP reduces POAF especially after postoperative day 2.
术后心房颤动（POAF）是心脏手术后的常见并发症。然而，仅有少数关于心律失常的详细描述被报道。我们旨在描述 POAF 的特征、结果以及与 POAF 相关的变量，并评估后心包切开术（PP）如何影响 POAF 的特征。
在心脏手术后预防心房颤动的左后心包切开术（PALACS）试验的事后分析中，我们根据连续住院遥测数据描述 POAF 的特征。
在 420 例患者中，103 例（24.5%）发生 POAF。中位发病时间为 50.3 小时；70.9%的事件发生在 3 天内。血流动力学不稳定和快速心室反应分别发生在 8.7%和 51.5%的病例中。大多数 POAF 患者接受了抗心律失常药物（97.1%）、22.3%的电复律和 40.8%的全身抗凝治疗。POAF 的中位持续时间为 24.0 小时；70.9%的病例在 36 小时内得到解决。POAF 的中位负荷为 15.9%。所有患者在随访时均处于窦性心律。POAF 与住院时间延长相关（7 天 vs 6 天；P <.001），但与死亡率或发病率增加无关。PP 降低了 POAF 的发生率（17.7% vs 31.3%；P =.001），特别是在术后第 2 天（POAF 发病时间 41.9 小时 vs 57.1 小时；P =.01）。年龄与 POAF 相关。女性、冠状动脉旁路移植术、β受体阻滞剂和 PP 与 POAF 呈负相关。
心脏手术后 POAF 仍然很常见。血流动力学不稳定很少见，尽管快速心室反应和需要电复律很常见。POAF 的负担很重，心律失常在 30 天内得到解决。PP 尤其是在术后第 2 天降低了 POAF 的发生率。
