New onset atrial fibrillation : pattern of presentation and 30-day outcome

Purpose: New postoperative atrial fibrillation (AF) is a common and persistent problem, impeding early recovery after cardiac surgery. When AF persists, anticoagulation is required that in turn leads to increased length of stay, and an increased of bleeding. Evidence describing the pattern of presentation of AF and time to inpatient resolution is scant. Methodology: We prospectively tracked 200 consecutive cases of new onset AF, in adult cardiac surgery patients, at a single metropolitan referral centre in Melbourne. 30-day follow-up was complete. Results: Of 823 patients from January 2014 to April 2015, 200 (24.3%) developed new AF, 52 hours (Q1 39, Q3 68) after surgery. AF persisted for 71.5 hours (Q1 19.8,Q3121.2) prior to reverting to sinus rhythm (SR). There were 186 (93%) patients discharged in SR, 13 (6.5%) requiring direct current reversion (DCR). Of 14 (7%) patients discharged in AF, 7 (3.5%) were warfarinised and 2 were readmitted within 30-days; 1 with pericardial effusion and symptoms of tamponade and 1 with ongoing AF and shortness of breath. There were 5 (2.7%) patients discharged in SR and readmitted in AF none of whom had DCR on readmission. Beta blockade was the most frequent anti-arrhythmia on discharge (n = 149, 74.5%) followed by digoxin (n = 75, 37.5%) and amiodarone (n = 54, 27%) and 38 (19%) patients were warfarinised. At 30-days 4 (2%) patients remained in AF. Conclusion: Few patients had persistent new AF on discharge and there were no major complications in this cohort.