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Epidemiology of new-onset atrial fibrillation following coronary artery bypass graft surgery
  1. Giovanni Filardo1,2,
  2. Ralph J Damiano Jr3,
  3. Gorav Ailawadi4,
  4. Vinod H Thourani5,
  5. Benjamin D Pollock1,
  6. Danielle M Sass1,
  7. Teresa K Phan1,
  8. Hoa Nguyen1,
  9. Briget da Graca2,6,7
  1. 1Department of Epidemiology, Center for Clinical Effectiveness, Baylor Scott & White Health, Dallas, Texas, USA
  2. 2Robbins Institute for Health Policy and Leadership, Baylor University, Waco, Texas, USA
  3. 3Department of Cardiac Surgery, Washington University School of Medicine and Barnes–Jewish Hospital, St Louis, Missouri, USA
  4. 4Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA
  5. 5Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia, USA
  6. 6Center for Clinical Effectiveness, Baylor Scott & White Health, Dallas, Texas, USA
  7. 7Center for Clinical Effectiveness, Office of the Chief Quality Officer, Baylor Scott & White Health, Dallas, Texas, USA
  1. Correspondence to Dr Giovanni Filardo, Department of Epidemiology, Center for Clinical Effectiveness, Baylor Scott and White Health, Dallas, TX75206, USA; giovanfi{at}baylorhealth.edu

Abstract

Objectives Postoperative atrial fibrillation (AF) following coronary artery bypass graft surgery (CABG) is significantly associated with reduced survival, but poor characterisation and inconsistent definitions present barriers to developing effective prophylaxis and management. We sought to address this knowledge gap.

Methods From 2002 to 2010, 11 239 consecutive patients without AF underwent isolated CABG at five sites. Clinical data collected for the Society of Thoracic Surgeons (STS) Database were augmented with details on AF detected via continuous in-hospital ECG/telemetry monitoring to assess new-onset post-CABG AF (adjusted for STS risk of mortality); time to first AF; durations of first and longest AF episodes; total in-hospital time in AF; number of in-hospital AF episodes; operative mortality; stroke; discharge in AF; and length of stay (LOS).

Results Unadjusted incidence of new-onset post-CABG AF was 29.5%. Risk-adjusted incidence was 33.1% and varied little over time (P=0.139). Among 3312 patients with post-CABG AF, adjusted median time to first AF was 52 (IQR: 48–55) hours; mean (SD) duration of first and longest events were 7.2 (5.3,9.1) and 13.1 (10.4,15.9) hours, respectively, and adjusted median total time in AF was 22 (IQR: 18–26) hours. Adjusted rates of operative mortality, stroke and discharge in AF did not vary significantly over time (P=0.156, P=0.965 and P=0.347, respectively). LOS varied (P=0.035), but in no discernible pattern.

Conclusions Each year, ~800 000 people undergo CABG worldwide; >264 000 will develop post-CABG AF. Onset is typically 2–3 days post-CABG and episodes last, on average, several hours. Effective prophylaxis and management is urgently needed to reduce associated risks of adverse outcomes.

  • coronary artery disease surgery
  • atrial fibrillation
  • epidemiology

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Footnotes

  • Contributors GF (guarantor): conception and design of the study, data acquisition, analysis and interpretation, drafting and critically revising it for important intellectual content, approval of the version to be published and agreement to be accountable for all aspects of the work. RJD, GA, VHT: conception and design of the study, data acquisition and interpretation, revising the draft critically for important intellectual content, approval of the version to be published and agreement to be accountable for all aspects of the work contributed. BDP: data analysis, drafting the manuscript, approval of the version to be published and agreement to be accountable for all aspects of the work contributed. TKP: data acquisition and interpretation, revising the draft critically for important intellectual content, approval of the version to be published and agreement to be accountable for all aspects of the work contributed. HN: data interpretation, revising the draft critically for important intellectual content, approval of the version to be published and agreement to be accountable for all aspects of the work contributed. DMS: data acquisition, revising the draft critically for important intellectual content, approval of the version to be published and agreement to be accountable for all aspects of the work contributed. BdG: drafting the manuscript, data interpretation, approval of the version to be published and agreement to be accountable for all aspects of the work contributed. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. GF affirms that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.

  • Funding This work was funded by National Institutes of Health/National Heart Lung Blood Institute (R01HL103683) and in part by the Bradley Family Endowment to the Baylor Health Care System Foundation and The Baylor Health Care System Cardiovascular Research Committee (Dallas, Texas).

  • Competing interests None declared.

  • Ethics approval Baylor Research Institute Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Study data contain individual identifiers; interested researchers will need to obtain waivers of informed consent and of authorisations for use and disclosure of this identifiable information from the institutional review boards at the participating sites before data can be shared for secondary research purposes.

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