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Natural Course of New-Onset Postoperative Atrial Fibrillation after Noncardiac Surgery

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Alternative Title
e018548
Abstract
Background Postoperative atrial fibrillation (POAF) is common after cardiac surgery, but little is known about its incidence and natural course after noncardiac surgery. We evaluated the natural course and clinical impact of POAF and the long-term impact of anticoagulation therapy in patients without a history of atrial fibrillation (AF) undergoing noncardiac surgery. Methods and Results We retrospectively analyzed the database of Asan Medical Center (Seoul, Korea) to identify patients who developed new-onset POAF after undergoing noncardiac surgery between January 2006 and January 2016. The main outcomes were AF recurrence, thromboembolic event, and major bleeding during follow-up. Of 322 688 patients who underwent noncardiac surgery, 315 patients (mean age, 66.4 years; 64.4% male) had new-onset POAF with regular rhythm monitoring after discharge. AF recurred in 53 (16.8%) during 2 years of follow-up. Hypertension (hazard ratio, 2.12; P=0.02), moderate-to-severe left atrial enlargement (hazard ratio, 2.33; P=0.007) were independently associated with recurrence. Patients with recurrent AF had higher risks of thromboembolic events (11.2% versus 0.8%; P<0.001) and major bleeding (26.9% versus 4.1%; P<0.001) than those without recurrence. Patients with recurrent AF and without anticoagulation were especially predisposed to thromboembolic events (P<0.001). Overall, anticoagulation therapy was not significantly associated with thromboembolic events (1.4% versus 2.5%, P=0.95). Conclusions AF recurred in 16.8% of patients with POAF after noncardiac surgery. AF recurrence was associated with higher risks of adverse clinical outcomes. Considering the high risk of anticoagulation-related bleeding, the benefits of routine anticoagulation should be carefully weighed in this population. Active surveillance for AF recurrence is warranted.
Author(s)
김민수김유호김준남기병도웅정조민수최기준현준호
Issued Date
2021
Type
Article
Keyword
postoperative atrial fibrillationanticoagulation recurrence
DOI
10.1161/JAHA.120.018548
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7210
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2503436691&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,Natural%20Course%20of%20New-Onset%20Postoperative%20Atrial%20Fibrillation%20after%20Noncardiac%20Surgery&amp;offset=0&amp;pcAvailability=true
Publisher
JOURNAL OF THE AMERICAN HEART ASSOCIATION
Location
미국
Language
영어
ISSN
2047-9980
Citation Volume
10
Citation Number
7
Citation Start Page
e018548
Citation End Page
e018548
Appears in Collections:
Medicine > Medicine
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