Prolonged postoperative atrial fibrillation (>48 Hours) identifies patients at risk of early and late heart failure and reduced survival after cardiac surgery
M Klinceva, A M Taseva Vasileva, N H Hristov, Z M MitrevAbstract
Background
Postoperative atrial fibrillation (POAF) is the most common arrhythmic complication after cardiac surgery. Its impact on the development of early and late heart failure (HF) and long-term survival is not fully characterized.
Purpose
To evaluate the association between POAF duration and the risk of early and late HF, as well as all-cause mortality after cardiac surgery.
Methods
We conducted a retrospective cohort study of consecutive patients at our Clinic who underwent cardiac surgery between 2020 and 2023. POAF was defined as new-onset atrial fibrillation during index hospitalization and categorized as ≤48 hours or >48 hours. HF was defined according to the 2021 ESC HF guidelines. Early HF was defined as HF requiring treatment during hospitalization or within 6 weeks postoperatively, while late HF was defined as HF occurring beyond 6 weeks. Follow-up was completed in December 2024. Clinical, echocardiographic, and perioperative data were extracted from the hospital information system. Logistic regression was used to assess the association between POAF duration and early HF. Late HF and all-cause mortality were analyzed using Cox proportional hazards models and Kaplan–Meier survival analysis with log-rank testing.
Results
Among 2,419 patients, 378 (16%) developed POAF; 193 (51%) had POAF ≤48 hours and 185 (49%) had POAF >48 hours. Early HF occurred in 22% of patients with POAF >48 hours versus 10% with POAF ≤48 hours (p=0.0016; OR 2.53, 95% CI 1.40–4.55). During follow-up, late HF occurred in 10% of patients with POAF >48 hours compared with 4% in the ≤48-hour group (p=0.039). Survival differed significantly by POAF duration (log-rank p=0.0001). Mean survival was 56 months (95% CI 52.21–57.72) for POAF ≤48 hours and 47 months (95% CI 44.01–51.18) for POAF >48 hours. In univariate Cox analysis, POAF >48 hours were associated with higher all-cause mortality (HR 4.70; 95% CI 1.78–12.42; p=0.002).
Conclusions
POAF lasting longer than 48 hours identifies patients at increased risk of early and late HF and reduced long-term survival after cardiac surgery. Prolonged POAF may serve as a marker for high-risk patients who could benefit from intensified monitoring and preventive strategies.