• Kevin K P Wang, Weiling Liu, ChewSophia T HSTHDepartment of Anaesthesiology, Singapore General Hospital, Singapore; Duke-NUS Graduate Medical School, Singapore., TiLian KahLKYong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Anesthesia, National University Health System, Singapore. Electronic address: anatilk@nus.edu.sg., and Liang Shen.
• Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
• J. Cardiothorac. Vasc. Anesth. 2021 Dec 1; 35 (12): 3559-3564.

ObjectivesThis study sought to determine the incidence and significance of new-onset atrial fibrillation as a risk factor for long-term stroke and mortality after cardiac surgery.DesignA prospective cohort study.SettingTwo large tertiary public hospitals.ParticipantsThe study comprised 3008 patients who underwent coronary artery bypass grafting and/or valve surgery from 2008 to 2012.InterventionsNone.Measurements And Main ResultsNew-onset atrial fibrillation was analyzed as a risk factor for postoperative stroke using a multivariate logistic regression model after adjustment for potential confounders. A Cox regression model with time-dependent variables was used to analyze relationships between new-onset atrial fibrillation and postoperative survival. New-onset atrial fibrillation was detected in 573 (19.0%) patients. Stroke occurred in 234 (7.8%) patients during the mean postoperative follow-up period of six ± two years. The incidence of postoperative stroke in patients with new-onset atrial fibrillation (9.9%) and patients with both preoperative and postoperative atrial fibrillation (13.8%) was higher than in patients with no atrial fibrillation (6.8%) (p = 0.002). New-onset atrial fibrillation (odds ratio, 1.53; 95% confidence interval [CI], 1.08-2.18; p = 0.017) was identified as an independent risk factor for postoperative stroke. A total of 518 (17.2%) mortalities occurred within the mean postoperative follow-up period of eight ± two years. New-onset atrial fibrillation was associated with shorter survival (hazard ratio, 1.49; 95% CI, 1.22-1.81; p < 0.001) compared with patients with no atrial fibrillation.ConclusionsNew-onset atrial fibrillation is a significant risk factor for long-term stroke and mortality after cardiac surgery. Close monitoring and treatment of this condition may be necessary to reduce the risk of postoperative stroke and mortality.Copyright © 2021. Published by Elsevier Inc.

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