Abstract

Introduction: Post-operative atrial fibrillation (AF) is the most common arrhythmic complication after CABG. Following inpatient treatment, data on the frequency and duration of recurrent AF after hospital discharge remain sparse. Research Question: Do patients who experience in-hospital post-operative AF have recurrent arrhythmias in the 30 days post discharge? Goals: To characterize the burden of AF after hospital discharge using a wearable telemetry device. Methods: Patients enrolled in the CTSN PACeS trial were eligible for this sub-study. PACeS is a randomized trial of anticoagulation versus no-anticoagulation in patients with new-onset post-operative AF. Eligibility criteria include patients with new onset AF defined as AF > lasting 60 minutes or recurrent AF episodes within 7 days after CABG and before hospital discharge. All patients in this sub-study wore a 3-lead mobile telemetry device upon hospital discharge that provided continuous beat-to-beat data for 30 days. For this analysis, an AF event was counted if it was at least 30 seconds in duration. Results: Forty-six patients participated in this sub-study. The mean age was 68.8 years, 21.7% were women, 78.3% White and 11% Hispanic. The mean and median device wear times were 23 and 29 days, respectively. The average total available analytic time (i.e., total time of interpretable electrocardiographic signal) was 20.3±3.3 hours/day. At least one episode of AF post-discharge was detected in 38 (82.6%) of patients. Among these, the median number of days in which patients had an episode of AF was 6. The mean duration of time in AF was 1.6±1.7 hours/day and the overall percent time in AF was 7.5%. Most patients (78.3%, n=36) had AF for <10% of the recording time. Nearly all AF events occurred within the first two weeks post discharge (Figure). Conclusions: In this telemetry study, patients who developed postoperative AF within 7 days of CABG were found to have a modest burden of post discharge AF episodes, most frequently within the first 2 weeks. These preliminary data should be verified in larger prospective studies, and may help inform anti-thrombotic and other management decisions for patients who develop AF following CABG surgery.