PM188 Screening for Recurrence of New-Onset Post-Operative Atrial Fibrillation: A Systematic Review and Meta-Analysis

Lowres, N; Mulcahy, G; Freedman, S B; Jin, K; Neubeck, L

Abstract

Poster abstract

Introduction
Post-operative atrial fibrillation (POAF) is associated with increased mortality and risk of stroke post-discharge. POAF is often thought to be transient, however recurrence is likely under-recognized as symptoms are an unreliable guide. Surveillance post-discharge may identify asymptomatic recurrences of AFObjectives
Determine the recurrence of POAF identified through post-discharge screening, in cardiac surgery patients with new-onset POAF discharged in stable sinus rhythm.

Methods
A systematic review and meta-analysis of studies investigating POAF recurrence post-discharge, in patients with new-onset POAF who reverted to sinus rhythm prior to discharge. Two independent reviewers searched medical databases (MEDLINE, EMBASE, and Cochrane Library); clinical trials registries; reference lists; and the internet, using predetermined search terms to identify relevant articles. The primary outcome was recurrence of POAF post-discharge.

Results
5,638 studies were screened, 47 full manuscripts reviewed, and 7 unique studies identified (n=1,136 participants; mean age 66 years; 73% male). Inter-rater agreement was κ 0.47 (CI, 0.28-0.66) for study selection stage one and κ 0.78 (CI, 0.58-0.98) for stage two. Monitoring methods varied widely, including: telemetry during twice daily exercise sessions (n=2); continuous telemetry for 3 weeks (n=1); daily 20-second ECG using wearable event recorder (n=1); 30-second single lead ECG, 4x/day (n=1); and implanted continuous monitoring (n=1). Incidence of POAF recurrence post-discharge was 30.1% (CI, 23.8-37.2%): Incidence varied depending on monitoring mode: extended telemetry monitoring identified 32-38%; implanted continuous monitoring identified 100% (9/9 patients); and intermittent brief recordings identified 23-26%. POAF recurred 12±5 days (mean±SD) post-surgery, and 40-69% of episodes were asymptomatic. In the one study reporting stroke risk, 80% of patients with recurrent AF had CHA2DS2-VASc score ≥2, an indication for prescribing oral anticoagulation for stroke prevention.

Conclusion
Monitoring for POAF recurrence after hospital discharge, can identify significant numbers of asymptomatic recurrences in patients who are at high risk of stroke and may benefit from early detection of POAF recurrence and anticoagulation for stroke prevention. More intense monitoring is more likely to identify POAF recurrence

Citation

Lowres, N., Mulcahy, G., Freedman, S. B., Jin, K., & Neubeck, L. (2016). PM188 Screening for Recurrence of New-Onset Post-Operative Atrial Fibrillation: A Systematic Review and Meta-Analysis. Global Heart, 11(2), e101. https://doi.org/10.1016/j.gheart.2016.03.351

• Journal Article Type: Other
• Online Publication Date: Jun 2, 2016
• Publication Date: Jun 2, 2016
• Deposit Date: Jan 30, 2017
• Journal: Global Heart
• Print ISSN: 2211-8160
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 11
• Issue: 2
• Pages: e101
• DOI: https://doi.org/10.1016/j.gheart.2016.03.351
• Keywords: Mortality, stroke, post-operation, atrial fibrillation, AF,
• Public URL: http://researchrepository.napier.ac.uk/Output/456355