A new study published in the Journal of American Medical
Association showed that even while the incidence of new-onset atrial
fibrillation (AF) during coronary artery bypass grafting (CABG) is greater than
anticipated, the total AF burden was extremely low, particularly after 30 days.
It is unknown how often new-onset atrial fibrillation is
during CABG. However, according to North American
recommendations, the patients with new-onset AF following CABG should get 60 days
of oral anticoagulation. This is a moderate-strength recommendation (class 2a)
based on data from nonrandomized clinical research. Therefore, this study evaluated the AF burden and test the hypothesis that the
incidence of new-onset AF during the first year following CABG is greater than
stated in the present literature.
198 patients with 3-vessel coronary artery disease or left
main disease and no prior history of arrhythmias who were given an insertable
cardiac monitor during CABG for long-term continuous electrocardiographic
monitoring were included in this study conducted
in two academic cardiac surgery centers in Germany.
The patients were monitored for
a year after being enrolled between November 2019 and November 2023. After a
year of continuous monitoring with implanted cardiac monitors during CABG,
atrial fibrillation was discovered. The cumulative incidence of new-onset AF
within a year following surgery was the main endpoint. Clinical results and the
burden of AF were secondary outcomes.
1008 of the 1217 patients that were evaluated were
eliminated. Within the first year following CABG, 95 of the 198 patients (mean
age, 66 [SD, 9] years; 173 male [87.4%]; 25 female [12.6%]) experienced
new-onset AF (cumulative incidence, 48%; 95% CI, 41%-55%).
During the first year, the median AF load was 370
minutes, or 0.07% (IQR, 0.02%-0.23%). On days 1 through 7, the median AF load
was 3.65% (IQR, 0.95%-9.09%); on days 8 through 30, it was 0.04% (IQR,
0%-1.21%); and on days 31 through 365, it was 0% (IQR, 0%-0.0003%), or 368, 13,
and 0 minutes, respectively. 3 patients experienced an AF episode lasting more
than 24 hours after being discharged.
Overall, the AF burden in these patients was extremely low, particularly after 30 days, despite the fact that the rate of new-onset AF following CABG in this research was greater than previously documented. The existing guidelines, which advocate long-term oral anticoagulation for patients with new-onset AF following CABG, are called into doubt by the extremely low AF burden.
Source:
Herrmann, F. E. M., Jeppsson, A., Kirov, H., Charitos, E. I., Dacian, D., Brömsen, J., Massberg, S., Sadoni, S., Doenst, T., Juchem, G., & Hagl, C. (2025). Long-term continuous monitoring of new-onset atrial fibrillation after coronary artery bypass grafting. JAMA: The Journal of the American Medical Association, 334(20), 1827–1835. https://doi.org/10.1001/jama.2025.14891
