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Variation in management of post-operative atrial fibrillation (POAF) after thoracic surgery

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Abstract

Objectives

New-onset post-operative atrial fibrillation (POAF) is a frequent adverse event following major thoracic surgery and is associated with increased risk of perioperative morbidity, length of stay and stroke. It is managed initially with rate and rhythm control therapy; however, optimal duration and the need for anticoagulation are poorly understood. This study aims to assess practice variation regarding POAF management and duration.

Methods

This retrospective, single-center cohort study included patients who underwent major thoracic surgery and developed POAF between 2008 and 2017, managed with rate and rhythm control therapy alone. Demographic, clinical, and surgical variables/outcomes, POAF management, and incidence of POAF recurrence in the 30-day post-operative period were collected. Chi-square and T-tests determined significance.

Results

Of 2054 patients undergoing thoracic surgery, 155 (75%) patients developed POAF. Different rate and rhythm control agents were used, most commonly metoprolol. 107 (69%) continued rate and rhythm control therapy upon hospital discharge for a mean of 56 days. Among the 48 patients with discontinuation of rate and rhythm control therapy on discharge, none demonstrated recurrence of POAF; in contrast to 3 of 107 patients who continued on therapy. Among patients with CHA2DS2-VASc score ≥ 2, 15% were prescribed anticoagulation on discharge.

Conclusions

Use of rate and rhythm control therapy and anticoagulation for POAF is significantly varied in practice. Many patients are not continued on rate and rhythm control after hospital discharge, which does not appear to impact risk of POAF recurrence. Further research to inform guidelines for POAF management, including therapy duration and indications for anticoagulation is warranted.

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Acknowledgements

The authors have no conflict of interest or disclosures to report.

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Author notes

  1. Heidi Oi-Yee Li and Heather Smith contributed equally to this work.

Authors and Affiliations

  1. Faculty of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Canada

    Heidi Oi-Yee Li & Olivier Brandts-Longtin

  2. Division of General Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, 725 Parkdale Ave, Ottawa, ON, K1Y4E9, Canada

    Heather A. Smith

  3. Division of Thoracic Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Canada

    Donna E. Maziak, Sebastien Gilbert, Paul Villeneuve, Sudhir Sundaresan & Andrew J. E. Seely

Authors
  1. Heidi Oi-Yee Li
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  2. Heather A. Smith
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  3. Olivier Brandts-Longtin
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  4. Donna E. Maziak
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  5. Sebastien Gilbert
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  7. Sudhir Sundaresan
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  8. Andrew J. E. Seely
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Contributions

Conception or design of the work: HS, AS. Data collection: HL, OBL. Data analysis and interpretation: HL, HS, OBL. Drafting the article: HL, HS. Critical revision of the article: HL, HS, AS, OBL, DM, SG, PV, SS, AS. Final approval of the version to be published: HL, HS, AS, OBL, DM, SG, PV, SS, AS.

Corresponding author

Correspondence to Heather A. Smith.

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Li, H.OY., Smith, H.A., Brandts-Longtin, O. et al. Variation in management of post-operative atrial fibrillation (POAF) after thoracic surgery. Gen Thorac Cardiovasc Surg 69, 1230–1235 (2021). https://doi.org/10.1007/s11748-020-01574-1

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  • DOI: https://doi.org/10.1007/s11748-020-01574-1

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