Determinants and impact of postoperative atrial fibrillation burden during 2.5 years of continuous rhythm monitoring after cardiac surgery: Results from the RACE V prospective cohort study

Martijn D. Gilbers; Michal J. Kawczynski; Elham Bidar; Bart Maesen; Aaron Isaacs; Joris Winters; Dominik Linz; Michiel Rienstra; Isabelle van Gelder; Jos G. Maessen; Ulrich Schotten

doi:10.1016/j.hrthm.2024.08.014

Determinants and impact of postoperative atrial fibrillation burden during 2.5 years of continuous rhythm monitoring after cardiac surgery: Results from the RACE V prospective cohort study

Martijn D. Gilbers, Michal J. Kawczynski, Elham Bidar, Bart Maesen, Aaron Isaacs, Joris Winters, Dominik Linz, Michiel Rienstra, Isabelle van Gelder, Jos G. Maessen, Ulrich Schotten^*

^*Corresponding author af dette arbejde

Physiology of circulation, kidney and lung

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Abstract

Background: Early postoperative atrial fibrillation (POAF) is common after cardiac surgery and is associated with late-POAF recurrences. However, little is known about the burden of POAF and its potential impact on long-term outcomes after cardiac surgery, particularly on the risk for late-POAF recurrences. Objective: The purpose of this study was to establish the distribution of POAF burden and to determine the association between early-POAF burden and late-POAF recurrences during 2.5 years of continuous rhythm monitoring after cardiac surgery in patients with and without preoperative history of atrial fibrillation (AF). Methods: Patients undergoing cardiac surgery were prospectively enrolled and postoperatively continuously monitored with an implantable loop recorder for 2.5 years. All patients underwent extensive clinical assessment at baseline. During follow-up, all AF episodes were registered, and AF associated metrics, such as burden, were calculated for different time intervals. Early-POAF was defined as AF within first 90 postoperative days and late-POAF as AF after this interval. Results: A total of 98 consecutive patients were included. POAF burden during the early postoperative phase was significantly higher compared to the late postoperative phase (P <.001). The longest individual POAF episode was strongly associated with increased POAF burden after adjusting for age, sex, and AF history (standardized Beta: 0.91, P <.001). Also, early-POAF burden was associated with late-POAF (re)occurrence after adjusting for age, sex, AF history (adjusted hazard ratio 1.93, 95% confidence interval 1.42–2.62, P <.001). Conclusion: POAF burden was significantly associated with the longest individual POAF episode duration. Additionally, greater early-POAF burden was associated with increased late-POAF incidence, highlighting its potential in estimating the risk for long-term POAF recurrences.

Originalsprog	Engelsk
Tidsskrift	Heart Rhythm
Vol/bind	22
Udgave nummer	3
Sider (fra-til)	647-660
ISSN	1547-5271
DOI	https://doi.org/10.1016/j.hrthm.2024.08.014
Status	Udgivet - 2025

Bibliografisk note

Funding Information:
This work was supported by the Netherlands Heart Foundation (CVON2014-09, RACE V Reappraisal of Atrial Fibrillation: Interaction between hyperCoagulability, Electrical remodeling, and Vascular Destabilisation in the Progression of AF, and Grant number 01-002-2022-0118, EmbRACE: Electro-Molecular Basis and the theRapeutic management of Atrial Cardiomyopathy, fibrillation and associated outcomEs), the European Union (ITN Network Personalize AF: Personalized Therapies for Atrial Fibrillation: a translational network, grant number 860974; CATCH ME: Characterizing Atrial fibrillation by Translating its Causes into Health Modifiers in the Elderly, grant number 633196; MAESTRIA: Machine Learning Artificial Intelligence Early Detection Stroke Atrial Fibrillation, grant number 965286).

Publisher Copyright:
© 2024 Heart Rhythm Society

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10.1016/j.hrthm.2024.08.014Licens: CC BY

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Citationsformater

Gilbers, M. D., Kawczynski, M. J., Bidar, E., Maesen, B., Isaacs, A., Winters, J., Linz, D., Rienstra, M., van Gelder, I., Maessen, J. G., & Schotten, U. (2025). Determinants and impact of postoperative atrial fibrillation burden during 2.5 years of continuous rhythm monitoring after cardiac surgery: Results from the RACE V prospective cohort study. Heart Rhythm, 22(3), 647-660. https://doi.org/10.1016/j.hrthm.2024.08.014

Determinants and impact of postoperative atrial fibrillation burden during 2.5 years of continuous rhythm monitoring after cardiac surgery: Results from the RACE V prospective cohort study. / Gilbers, Martijn D.; Kawczynski, Michal J.; Bidar, Elham et al.
I: Heart Rhythm, Bind 22, Nr. 3, 2025, s. 647-660.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Gilbers, MD, Kawczynski, MJ, Bidar, E, Maesen, B, Isaacs, A, Winters, J, Linz, D, Rienstra, M, van Gelder, I, Maessen, JG & Schotten, U 2025, 'Determinants and impact of postoperative atrial fibrillation burden during 2.5 years of continuous rhythm monitoring after cardiac surgery: Results from the RACE V prospective cohort study', Heart Rhythm, bind 22, nr. 3, s. 647-660. https://doi.org/10.1016/j.hrthm.2024.08.014

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title = "Determinants and impact of postoperative atrial fibrillation burden during 2.5 years of continuous rhythm monitoring after cardiac surgery: Results from the RACE V prospective cohort study",

abstract = "Background: Early postoperative atrial fibrillation (POAF) is common after cardiac surgery and is associated with late-POAF recurrences. However, little is known about the burden of POAF and its potential impact on long-term outcomes after cardiac surgery, particularly on the risk for late-POAF recurrences. Objective: The purpose of this study was to establish the distribution of POAF burden and to determine the association between early-POAF burden and late-POAF recurrences during 2.5 years of continuous rhythm monitoring after cardiac surgery in patients with and without preoperative history of atrial fibrillation (AF). Methods: Patients undergoing cardiac surgery were prospectively enrolled and postoperatively continuously monitored with an implantable loop recorder for 2.5 years. All patients underwent extensive clinical assessment at baseline. During follow-up, all AF episodes were registered, and AF associated metrics, such as burden, were calculated for different time intervals. Early-POAF was defined as AF within first 90 postoperative days and late-POAF as AF after this interval. Results: A total of 98 consecutive patients were included. POAF burden during the early postoperative phase was significantly higher compared to the late postoperative phase (P <.001). The longest individual POAF episode was strongly associated with increased POAF burden after adjusting for age, sex, and AF history (standardized Beta: 0.91, P <.001). Also, early-POAF burden was associated with late-POAF (re)occurrence after adjusting for age, sex, AF history (adjusted hazard ratio 1.93, 95% confidence interval 1.42–2.62, P <.001). Conclusion: POAF burden was significantly associated with the longest individual POAF episode duration. Additionally, greater early-POAF burden was associated with increased late-POAF incidence, highlighting its potential in estimating the risk for long-term POAF recurrences.",

keywords = "Atrial fibrillation burden, Cardiac surgery, Clinical predictors, Postoperative atrial fibrillation, Risk assessment",

author = "Gilbers, {Martijn D.} and Kawczynski, {Michal J.} and Elham Bidar and Bart Maesen and Aaron Isaacs and Joris Winters and Dominik Linz and Michiel Rienstra and {van Gelder}, Isabelle and Maessen, {Jos G.} and Ulrich Schotten",

note = "Publisher Copyright: {\textcopyright} 2024 Heart Rhythm Society",

year = "2025",

doi = "10.1016/j.hrthm.2024.08.014",

language = "English",

volume = "22",

pages = "647--660",

journal = "Heart Rhythm",

issn = "1547-5271",

publisher = "Elsevier",

number = "3",

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TY - JOUR

T1 - Determinants and impact of postoperative atrial fibrillation burden during 2.5 years of continuous rhythm monitoring after cardiac surgery

T2 - Results from the RACE V prospective cohort study

AU - Gilbers, Martijn D.

AU - Kawczynski, Michal J.

AU - Bidar, Elham

AU - Maesen, Bart

AU - Isaacs, Aaron

AU - Winters, Joris

AU - Linz, Dominik

AU - Rienstra, Michiel

AU - van Gelder, Isabelle

AU - Maessen, Jos G.

AU - Schotten, Ulrich

PY - 2025

Y1 - 2025

N2 - Background: Early postoperative atrial fibrillation (POAF) is common after cardiac surgery and is associated with late-POAF recurrences. However, little is known about the burden of POAF and its potential impact on long-term outcomes after cardiac surgery, particularly on the risk for late-POAF recurrences. Objective: The purpose of this study was to establish the distribution of POAF burden and to determine the association between early-POAF burden and late-POAF recurrences during 2.5 years of continuous rhythm monitoring after cardiac surgery in patients with and without preoperative history of atrial fibrillation (AF). Methods: Patients undergoing cardiac surgery were prospectively enrolled and postoperatively continuously monitored with an implantable loop recorder for 2.5 years. All patients underwent extensive clinical assessment at baseline. During follow-up, all AF episodes were registered, and AF associated metrics, such as burden, were calculated for different time intervals. Early-POAF was defined as AF within first 90 postoperative days and late-POAF as AF after this interval. Results: A total of 98 consecutive patients were included. POAF burden during the early postoperative phase was significantly higher compared to the late postoperative phase (P <.001). The longest individual POAF episode was strongly associated with increased POAF burden after adjusting for age, sex, and AF history (standardized Beta: 0.91, P <.001). Also, early-POAF burden was associated with late-POAF (re)occurrence after adjusting for age, sex, AF history (adjusted hazard ratio 1.93, 95% confidence interval 1.42–2.62, P <.001). Conclusion: POAF burden was significantly associated with the longest individual POAF episode duration. Additionally, greater early-POAF burden was associated with increased late-POAF incidence, highlighting its potential in estimating the risk for long-term POAF recurrences.

AB - Background: Early postoperative atrial fibrillation (POAF) is common after cardiac surgery and is associated with late-POAF recurrences. However, little is known about the burden of POAF and its potential impact on long-term outcomes after cardiac surgery, particularly on the risk for late-POAF recurrences. Objective: The purpose of this study was to establish the distribution of POAF burden and to determine the association between early-POAF burden and late-POAF recurrences during 2.5 years of continuous rhythm monitoring after cardiac surgery in patients with and without preoperative history of atrial fibrillation (AF). Methods: Patients undergoing cardiac surgery were prospectively enrolled and postoperatively continuously monitored with an implantable loop recorder for 2.5 years. All patients underwent extensive clinical assessment at baseline. During follow-up, all AF episodes were registered, and AF associated metrics, such as burden, were calculated for different time intervals. Early-POAF was defined as AF within first 90 postoperative days and late-POAF as AF after this interval. Results: A total of 98 consecutive patients were included. POAF burden during the early postoperative phase was significantly higher compared to the late postoperative phase (P <.001). The longest individual POAF episode was strongly associated with increased POAF burden after adjusting for age, sex, and AF history (standardized Beta: 0.91, P <.001). Also, early-POAF burden was associated with late-POAF (re)occurrence after adjusting for age, sex, AF history (adjusted hazard ratio 1.93, 95% confidence interval 1.42–2.62, P <.001). Conclusion: POAF burden was significantly associated with the longest individual POAF episode duration. Additionally, greater early-POAF burden was associated with increased late-POAF incidence, highlighting its potential in estimating the risk for long-term POAF recurrences.

KW - Atrial fibrillation burden

KW - Cardiac surgery

KW - Clinical predictors

KW - Postoperative atrial fibrillation

KW - Risk assessment

U2 - 10.1016/j.hrthm.2024.08.014

DO - 10.1016/j.hrthm.2024.08.014

M3 - Journal article

C2 - 39121980

AN - SCOPUS:85203632942

SN - 1547-5271

VL - 22

SP - 647

EP - 660

JO - Heart Rhythm

JF - Heart Rhythm

IS - 3

ER -