Incidence of postoperative atrial fibrillation recurrence in patients discharged in sinus rhythm after cardiac surgery: a systematic review and meta-analysis

Lowres, Nicole; Mulcahy, Georgina; Jin, Kai; Gallagher, Robyn; Neubeck, Lis; Freedman, Ben

Abstract

Post-operative atrial fibrillation (POAF) is associated with increased stroke risk and mortality post-discharge. POAF is often considered transient, however recurrence is likely under-recognized as symptoms are an unreliable guide. Surveillance post- discharge may identify asymptomatic POAF recurrences in patients discharged in sinus rhythm. Therefore, we performed a systematic review and meta-analysis of studies investigating POAF recurrence post-discharge, in patients with new-onset POAF following cardiac surgery who reverted to sinus rhythm prior to discharge. Two independent reviewers searched medical databases, clinical trial registries, reference lists, and the internet. From 6,525 studies screened, 8 studies were identified (n=1,157 participants; mean 66±10 years; 73% male). Monitoring methods included: 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=2). Incidence rate of POAF recurrence identified through non-invasive monitoring in the first 4-weeks post-discharge was 28.3% (CI, 23.0-33.6%); recurring 12±5 days (mean ± SD) post- surgery. Incidence identified through implanted continuous monitoring was 61-100% within 2-years. Between 40-93% of episodes were asymptomatic. In one small study reporting stroke risk, 8/10 patients with recurrence were guideline-indicated (CHA2DS2-VASc score ≥2) for oral-anticoagulation for stroke prevention. Monitoring for POAF recurrence post-hospital discharge identifies significant numbers of early asymptomatic recurrences in patients at high risk of stroke, who may benefit from anticoagulation for stroke prevention. More intense monitoring is more likely to identify POAF recurrence. Future research is required to investigate the prognostic significance of POAF recurrence, especially stroke and mortality risk.

Citation

Lowres, N., Mulcahy, G., Jin, K., Gallagher, R., Neubeck, L., & Freedman, B. (2018). Incidence of postoperative atrial fibrillation recurrence in patients discharged in sinus rhythm after cardiac surgery: a systematic review and meta-analysis. Interactive Cardiovascular and Thoracic Surgery, 26(3), 504-511. https://doi.org/10.1093/icvts/ivx348

• Journal Article Type: Article
• Acceptance Date: Sep 29, 2017
• Online Publication Date: Nov 17, 2017
• Publication Date: Mar 1, 2018
• Deposit Date: Oct 12, 2017
• Publicly Available Date: Nov 18, 2018
• Journal: Interactive Cardiovascular and Thoracic Surgery
• Print ISSN: 1569-9293
• Electronic ISSN: 1569-9285
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 26
• Issue: 3
• Pages: 504-511
• DOI: https://doi.org/10.1093/icvts/ivx348
• Keywords: Post-operative, atrial fibrillation, screening, recurrence, electrocardiogram
• Public URL: http://researchrepository.napier.ac.uk/Output/991835
• Contract Date: Oct 12, 2017