Postoperative atrial fibrillation linked to late mortality

Researchers have provided strong evidence for the direct association of post-operative atrial fibrillation (AF) with an increase in late mortality following cardiac surgery. AF is a common complication following coronary artery bypass surgery (CABG) leading to substantial disease burden and mortality. While the negative consequences of chronic AF are well established, the prognostic implications of post-cardiac-surgery AF are less clear. Existing studies showing an association between postoperative AF and mortality after cardiac surgery have been criticised for methodological flaws, and to date, no study has presented compelling data to support an independent association between postoperative AF and late mortality. Researchers conducted a prospective observational study of patients undergoing isolated CABG to determine the impact of AF on postoperative survival and to assess the prognostic role of post-operative AF on cause-specific mortality (cardiac cause). Of the 1832 patients included in the study, 570 patients (31%) developed AF following cardiac surgery. Patients identified as being affected by post-operative AF were followed up until death or study end. They found that postoperative AF tripled the risk of dying of cardiac cause, quadrupled the risk of disabling embolic events, and increased the risk of dying of any cause by 2- to 3-fold. Specifically, the long-term mortality rates were significantly worse in patients with postoperative AF (2.99 per 100 person years) compared with those without AF (1.34 per 100 person years) with a hazard ratio (HR) of 2.26. Furthermore, similar estimates of increased risk of death were observed following adjustment for confounding factors.  “Our study provides the first strong evidence that postoperative AF increases late mortality after cardiac surgery and is associated with attendant thrombotic events,” the researchers said.  Anti-arrhythmic and antithrombotic prophylaxis should be considered following CABG surgery, they concluded. Reference Mariscalco, G. Klersy, C. 2008, ‘Atrial fibrillation after isolated coronary surgery affects late survival’ Circulation; 118: 1612—1618....