Preoperative Atrial Fibrillation Decreases Event-free Survival Following Cardiac Surgery

Objective: To investigate the relationship between preoperative atrial fibrillation and early and late clinical outcomes following cardiac surgery.

Methods: A retrospective cohort including all consecutive coronary artery bypass graft and/or valve surgery patients between 1995 and 2005 was identified (n = 9796). No patient had a concomitant surgical AF ablation. The association between preoperative atrial fibrillation and in-hospital outcomes was examined. We also determined late death and cardiovascular-related re-hospitalization by linking to administrative health databases. Median follow-up was 2.9 years (maximum 11 years).

Results: The prevalence of preoperative atrial fibrillation was 11.3% (n = 1105), ranging from 7.2% in isolated CABG to 30% in valve surgery. In-hospital mortality, stroke, and renal failure were more common in atrial fibrillation patients (all p < 0.0001), although the association between atrial fibrillation and mortality was not statistically significant in multivariate logistic regression. Longitudinal analyses showed that preoperative atrial fibrillation was associated with decreased event-free survival (adjusted hazard ratio 1.55, 95% confidence interval 1.42-1.70, p < 0.0001).

Conclusions: Preoperative atrial fibrillation is associated with increased late mortality and recurrent cardiovascular events post-cardiac surgery. Effective management strategies for atrial fibrillation need to be explored and may provide an opportunity to improve the long-term outcomes of cardiac surgical patients.