Subclinical postoperative atrial fibrillation: a randomized trial

Avi Sabbag; Anat Berkovich; Ehud Raanani; David Volvovitch; William F McIntyre; Yigal Kassif; Alexander Kogan; Michael Glikson; Roy Beinart

doi:10.3389/fcvm.2023.1153275

Subclinical postoperative atrial fibrillation: a randomized trial

Front Cardiovasc Med. 2023 May 25:10:1153275. doi: 10.3389/fcvm.2023.1153275. eCollection 2023.

Authors

Avi Sabbag^{1

2}, Anat Berkovich^{1

2}, Ehud Raanani^{2

3}, David Volvovitch^{2

3}, William F McIntyre⁴, Yigal Kassif^{2

3}, Alexander Kogan^{2

3}, Michael Glikson⁵, Roy Beinart^{1

2}

Affiliations

¹ Davidai Arrhythmia Center, Sheba Medical Center, Ramat Gan, Israel.
² Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
³ Department of Cardiac Surgery, Sheba Medical Center, Ramat Gan, Israel.
⁴ Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
⁵ Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel.

Abstract

Background: Postoperative atrial fibrillation (POAF) is the most common complication of cardiac surgery, requiring interventions and prolonging hospital stay. POAF is associated with increased mortality and a higher rate of systemic thrombo-embolism. The rates of recurrent AF, optimal follow-up and management remain unclear. We aimed to evaluate the incidence of recurrent atrial fibrillation (AF) events, during long term follow-up in patients with POAF following cardiac surgery.

Methods: Patients with POAF and a CHA₂DS₂-VASc score of ≥2 were randomized in a 2:1 ratio to either implantation of a loop recorder (ILR) or ECG monitoring using periodic Holters. Participants were followed prospectively for 2 years. The primary end point was the occurrence of AF longer than 5 min.

Results: The final cohort comprised of 22 patients, of whom 14 received an ILR. Over a median follow up of 25.7 (IQR of 24.7-44.4) months, 8 patients developed AF, representing a cumulative annualized risk of AF recurrence of 35.7%. There was no difference between ILR (6 participants, 40%) and ECG/Holter (2 participants, 25% p = 0.917). All 8 patients with AF recurrence were treated with oral anticoagulation. There were no cases of mortality, stroke or major bleeding. Two patients underwent ILR explantation due to pain at the implantation site.

Conclusions: The rate of recurrent AF in patients with POAF after cardiac surgery and a CHA₂DS₂-VASc score of ≥2 is approximately 1 in 3 when followed systematically. Further research is need to assess the role of ILRs in this population.

Keywords: atrial fibrillation; cardiac surgery; implantable loop recorder; post-operative atrial fibrillation; stroke.

Grants and funding

This investigator-initiated study was funded by an unrestricted grant form Pfizer Inc. via the BMS/Pfizer European Thrombosis Investigator Initiated Research Program (ERISTA) and by an additional unrestricted grant form Biotronik Inc. Neither company was involved in the study design, data collection, analysis or interpretation. The manuscript was written solely by the authors.