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Pre- and postoperative atrial fibrillation in CABG patients have similar prognostic impact
Örebro University, School of Health Sciences. Departments of Cardiology and Cardiothoracic Surgery, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0002-2654-9427
Department of Clinical Sciences, South Hospital and Arrhythmia Center, Karolinska Institute, Stockholm, Sweden.
Örebro University, School of Medical Sciences. Departments of Cardiology and Cardiothoracic Surgery, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0002-6913-0669
2017 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 51, no 1, p. 21-27Article in journal (Refereed) Published
Abstract [en]

Objectives: To study pre- and postoperative atrial fibrillation and its long-term effects in a cohort of aortocoronary bypass surgery patients.

Design: Altogether 615 patients undergoing aortocoronary bypass graft surgery in 1999-2000 were studied. Forty-four (7%) had preoperative atrial fibrillation. Postoperative atrial fibrillation occurred in 165/615 patients (27%) while 406/615 patients (66%) had no atrial fibrillation. After a median follow-up of 15 years, symptoms and medication in survivors were recorded, and cause of death in the deceased was obtained.

Results: Death due to cerebral ischaemia was most common in the pre- and postoperative atrial fibrillation groups (7% and 5%, respectively, v. 2% among those without atrial fibrillation, p = 0.038), as were death due to heart failure (18% and 14%, v. 7%, p = 0.007) and sudden death (9% and 5%, v. 2%, p = 0.029). The presence of pre- or postoperative atrial fibrillation was an independent risk factor for late mortality (hazard ratios 1.47 (1.02-2.12) and 1.28 (1.01-1.63), respectively).

Conclusions: Patients with pre- or postoperative atrial fibrillation undergoing aortocoronary bypass surgery have increased long-term mortality and risk of cerebral ischemic and cardiovascular death compared with patients in sinus rhythm.

Place, publisher, year, edition, pages
Taylor & Francis, 2017. Vol. 51, no 1, p. 21-27
Keywords [en]
Atrial fibrillation, bypass surgery, cerebral ischaemia, anticoagulation, survival
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:oru:diva-52180DOI: 10.1080/14017431.2016.1234065ISI: 000392468400004PubMedID: 27615545Scopus ID: 2-s2.0-84988640946OAI: oai:DiVA.org:oru-52180DiVA, id: diva2:972627
Note

Funding Agency:

Research Committee, Orebro University Hospital  136/04

Available from: 2016-09-21 Created: 2016-09-14 Last updated: 2018-09-04Bibliographically approved
In thesis
1. Atrial fibrillation: endoscopic ablation and postoperative studies
Open this publication in new window or tab >>Atrial fibrillation: endoscopic ablation and postoperative studies
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: Atrial fibrillation (AF) is associated with an increased risk of stroke, heart failure and cardiovascular death. Initial treatment focuses on rhythm or rate control and anticoagulation after risk assessment. Catheter abla-tion (CA) is an option in highly symptomatic patients but is less effective in long-standing persistent AF(LSPAF). Total endoscopic ablation is an alternative, but its clinical role needs further evaluation. In patients undergoing aortocoronary bypass graft (CABG) surgery, up to 9 % present with preoperative AF. One-third experience postoperative AF, which is associated with increased hospital stay, risk of stroke and decreased long-term survival. The long-term effects on heart rhythm have not been studied.

Methods and Results: 571 patients undergoing CABG from 1999 to 2000 were followed for six years. Postoperative AF was the strongest independent risk factor for late AF and an age-independent risk factor for late mortality. 615 pa-tients from the same cohort, including patients with preoperative AF, were fol-lowed up at 15 years. Death due to cerebral ischaemia, heart failure and sudden death were most common in the pre- and postoperative AF groups. The presence of pre- or postoperative AF was an independent risk factor for late mortality.

In our first ten patients, total endoscopic ablation of AF using a right-sided unilateral approach was feasible and safe with acceptable results. 36 patients with symptomatic LSPAF were then randomized to total endoscopic ablation or rate control. Loop recorders were implanted in all patients. In the control group, all patients were in permanent AF for 12 months. In the ablation group, 12/15 patients (80%) were in SR without antiarrhythmic drugs at 12 months. Median freedom of AF at 3–12 months was 95%, and 8/15 (53%) had an AF burden of < 5%. Myocardial function, physical working capacity(PWC) and subjective physical and mental health improved.

Conclusions: Postoperative AF patients have an eightfold increased risk of future AF and a doubled long-term cardiovascular mortality. Both pre- or post-operative AF in CABG patients is a major risk factor for late cardiovascular morbidity and mortality. Total endoscopic ablation of AF is feasible and safe. In patients with LSPAF, it significantly reduced AF burden at 12 months compared with controls. Myocardial function, PWC and subjective physical and mental health improved.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2017. p. 111
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 169
Keywords
Atrial fibrillation, Bypass surgery, Cerebral ischemia, Follow-up studies, Survival, Anticoagulation, Ablation, Endoscopy, Randomized trial, Implantable loop recorder
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-61949 (URN)978-91-7529-220-5 (ISBN)
Public defence
2018-01-19, Örebro universitet, Campus USÖ, hörsal C2, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2017-10-24 Created: 2017-10-24 Last updated: 2018-01-13Bibliographically approved

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Fengsrud, EspenAhlsson, Anders

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