New-onset AFib is common after CABG—but typically not persistent or symptomatic
New-onset atrial fibrillation (AFib) after coronary artery bypass grafting (CABG) is relatively common, according to new data published in JAMA.[1] However, the AFib burden for these patients is low, especially after 30 days.
The study’s authors focused on data from nearly 200 patients who underwent CABG for three-vessel coronary artery disease or left main disease from 2019 to 2023. The mean age was 66 years old. All patients had an insertable cardiac monitor (ICM) implanted after the procedure to detect any signs of an arrhythmia.
The study’s primary outcome—new-onset AFib—was seen in 48% of patients, which was more than expected. The median AFib burden within the first year for those patients, meanwhile, was just 0.07%. After one week, the median AFib burden was 3.65%. For days eight through 30, the median AFib burden was 0.04%. And for days 31 through 365, the median AFib burden was 0%.
The median time to incident AFib episode was 3.3 days, and the median episode length was six minutes. In addition, 63% of AFib episodes were asymptomatic and 67% would not have been detected by standard monitoring.
“Although the incidence of new-onset AFib after CABG is higher than previously reported, the burden both within the first 30 days and later than 30 days after surgery is very low,” wrote first author Florian E. M. Herrmann, MD, a cardiac surgeon with LMU University Hospital in Germany, and colleagues. “Episodes with a duration of 24 or more hours are very rare. After discharge, AF is largely subclinical and of short duration.”
Herrmann et al. also questioned if patients should really be given oral anticoagulation medications for new-onset AFib following heart surgery as currently recommended.
“The data in this current study suggest that if oral anticoagulation is initiated after surgery in patients with new-onset AFib, a reevaluation of the need for its continuation should be performed 30 days after surgery,” they wrote.
Click here for the full analysis.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.