Clinical Predictors of Device-Detected Atrial Fibrillation During 2.5 Years After Cardiac Surgery: Prospective RACE V Cohort.

Background: Postoperative atrial fibrillation (POAF) is a frequent complication after cardiac surgery that is associated with late atrial fibrillation (AF) recurrences (late-POAF) and increased morbidity and long-term mortality.
Objectives: This study sought to determine device-detected POAF incidence and to identify clinical variables associated with POAF, both in patients with and without preoperative AF history.
Methods: A total of 133 consecutive patients undergoing cardiac surgery were prospectively enrolled and continuously monitored with an implantable loop recorder for 2.5 years after surgery. Preoperative transthoracic echocardiography, 12-lead electrocardiogram, blood biomarkers, and clinical data were analyzed to develop prediction models for early- and late-POAF.
Results: In patients without preoperative AF history, early-POAF within the first 90 postoperative days occurred in 41 (47.1%) of 87 patients. Late-POAF after the first 90 postoperative days occurred in 22 (25%) of 87 patients, and 20 of these patients also had early-POAF during the first 90 days (20 of 22 [91%]). Increased right atrial minimum volume indexed for body surface area (RAVI _min ) and early-POAF were independently associated with late-POAF. A prediction model for late-POAF, which included RAVI _min >11 mL/m ² , age >65 years, and early-POAF, achieved an area under the curve of 0.82 (95% CI: 0.72-0.92). For patients with preoperative AF-history, late-POAF recurrences were frequent (22 of 33 [67%]). Increased RAVI _min was independently associated with a higher incidence of late-POAF.
Conclusions: In patients with and without AF history, late-POAF recurrences are frequent, including in patients undergoing surgical AF ablation. In patients with no history of AF, late-POAF might be predicted with excellent accuracy by using a combination of preoperative variables. In patients with a history of AF, signs of advanced AF substrate (eg, increased right atrial volumes) were associated with long-term AF recurrences. [Reappraisal of Atrial Fibrillation: Interaction Between Hypercoagulability, Electrical Remodeling, and Vascular Destabilisation in the Progression of AF; NCT03124576].
Competing Interests: Funding Support and Author Disclosures This work was supported by the Netherlands Heart Foundation (CVON2014-09, RACE V [Reappraisal of Atrial Fibrillation: Interaction Between Hypercoagulability, Electrical Remodeling, and Vascular Destabilisation in the Progression of AF]; and grant number 01-002-2022-0118, EmbRACE [Electro-Molecular Basis and the Therapeutic management of Atrial Cardiomyopathy, Fibrillation and Associated Outcomes]), the European Union (ITN Network Personalize AF: Personalized Therapies for Atrial Fibrillation: a translational network, grant number 860974; CATCH ME [Characterizing Atrial fibrillation by Translating its Causes into Health Modifiers in the Elderly], grant number 633196; and MAESTRIA [Machine Learning Artificial Intelligence Early Detection Stroke Atrial Fibrillation], grant number 965286). Dr Schotten has received consultancy fees or honoraria from Università della Svizzera Italiana, Roche Diagnostics, EP Solutions Inc, Johnson & Johnson Medical Limited, and Bayer Healthcare; and is co-founder and shareholder of YourRhythmics BV, a spin-off company of the University Maastricht. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)