Subclinical postoperative atrial fibrillation: a randomized trial

Frontiers in Cardiovascular Medicine

Cardiovascular Medicine

Avi Sabbag¹  Anat Berkovich¹  Roy Beinart¹  Michael Glikson²  William F. McIntyre³  Ehud Raanani⁴  Yigal Kassif⁴  Alexander Kogan⁴  David Volvovitch⁴ 

[1] Davidai Arrhythmia Center, Sheba Medical Center, Ramat Gan, Israel;Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel;Population Health Research Institute, McMaster University, Hamilton, ON, Canada;Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;Department of Cardiac Surgery, Sheba Medical Center, Ramat Gan, Israel;

关键词: post-operative atrial fibrillation;    implantable loop recorder;    stroke;    atrial fibrillation;    cardiac surgery;   

DOI  :  10.3389/fcvm.2023.1153275

 received in 2023-01-29, accepted in 2023-05-02,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundPostoperative atrial fibrillation (POAF) is the most common complication of cardiac surgery, requiring interventions and prolonging hospital stay. POAF is associated with increased mortality and a higher rate of systemic thrombo-embolism. The rates of recurrent AF, optimal follow-up and management remain unclear. We aimed to evaluate the incidence of recurrent atrial fibrillation (AF) events, during long term follow-up in patients with POAF following cardiac surgery.MethodsPatients with POAF and a CHA2DS2-VASc score of ≥2 were randomized in a 2:1 ratio to either implantation of a loop recorder (ILR) or ECG monitoring using periodic Holters. Participants were followed prospectively for 2 years. The primary end point was the occurrence of AF longer than 5 min.ResultsThe final cohort comprised of 22 patients, of whom 14 received an ILR. Over a median follow up of 25.7 (IQR of 24.7–44.4) months, 8 patients developed AF, representing a cumulative annualized risk of AF recurrence of 35.7%. There was no difference between ILR (6 participants, 40%) and ECG/Holter (2 participants, 25% p = 0.917). All 8 patients with AF recurrence were treated with oral anticoagulation. There were no cases of mortality, stroke or major bleeding. Two patients underwent ILR explantation due to pain at the implantation site.ConclusionsThe rate of recurrent AF in patients with POAF after cardiac surgery and a CHA2DS2-VASc score of ≥2 is approximately 1 in 3 when followed systematically. Further research is need to assess the role of ILRs in this population.

【 授权许可】

Unknown   
© 2023 Sabbag, Berkovich, Raanani, Volvovitch, McIntyre, Kassif, Kogan, Glikson and Beinart.