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DOI: 10.1055/s-0043-1761806
New Postoperative Atrial Fibrillation: Impact on Functional Recovery, Quality of Life, Mortality, and Predictors of AF Manifestation
Background: Postoperative atrial fibrillation (POAF) is a common complication following thoracic surgery. It is directly linked to increased morbidity and mortality for patients. We investigated how POAF influences cardiac rhythms, quality of life, and mortality and whether electrocardiographic predictors can forecast cardiac arrhythmias following POAF.
Method: Cardiac surgery patients who developed POAF or maintained sinus rhythm from June 2016 and August 2017 were contacted for follow-up after 2 years (n = 200). POAF patients were propensity score matched sins rhythm (SR) patients. We analyzed ECG and echocardiographic parameters regarding predictive value for de-novo-AF manifestation. Long-term outcomes were analyzed: 6-minute walking test, serological characterization and questionnaires for physical and psychological were performed.
Results: All patients were discharged from primary surgical care in SR. After a 2 year follow up 23% of patients had died (all-cause mortality), and 6% refused examinations. None of the POAF patients showed atrial fibrillation (AF). However, 13% of POAF and 6.5% of SR patients reported documented paroxysmal AF events (p = 0.285) during the past 2 years. Functional recovery (POAF vs. sinus rhythm) was not different. In SF-12, the average PCS score was 45.27 (POAF: 45.19 vs. SR: 45.34; p = 0,951) and an MCS of 49.5 (POAF: 49.3 vs. SR: 49.6; p = 0,929). Compared with the age-adjusted reference, the MCS showed a mean difference of −1.07 (POAF: −1.12 vs. SR: −1.02; p = 0.284). Mortality was 63% higher in the POAF group than in the SR group (p = 0.213). A significantly higher number of patients with three or more ECG-related risk factors for de novo AF existed in the POAF cohort (p < 0.001). Morphological echocardiographic parameters did not differ between POAF and SR and had no predictive value.
Conclusion: Paroxysmal AF is more frequent in POAF patients in long-term follow-up. Functional recovery of POAF patients is not different from SR patients, while mental health is reduced and all-cause mortality increased. ECG abnormalities may serve as predictors for POAF and de novo AF and help to identify individuals at risk.
Publication History
Article published online:
28 January 2023
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