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Post-Operative A-Fib Happens Too Often and is Dangerous
A friend of ours had to undergo heart bypass surgery. Though I forewarned him, he did go into A-Fib after surgery. It’s called Post-operative A-Fib (POAF).
Why did this happen? The surgeon didn’t pretreat him before the surgery so that he wouldn’t get A-Fib.
Fortunately, after the surgery, the surgeon did put him on a protocol (amiodarone for a short time) that did bring him back into normal sinus rhythm. Luckily, he has remained free of A-Fib. Not all surgery patients are so lucky.
Post-operative atrial fibrillation (POAF) is a well-recognized consequence of surgery.
Nonetheless, doctors tend to view Post-Operative A-Fib as a benign event, triggered by the stress of the surgery.
Observational Study: How Often Does POAF Occur?
In an observational retrospective study of nearly 3 million patients, researchers collected data on health claims from 2016 to 2018 for discharges from acute care hospitals across 11 states in the USA.
Patients were followed up for an average (median) of 1.7 years. The researchers adjusted their analyses to account for factors that could affect the results such as age, sex, race, insurance status, medical history and body mass index.
Study Findings: Among 76,536 patients who underwent heart surgery, 14,365 (18.8%) developed A-Fib.
Among 2,929,854 patients without a history of heart disease who had surgery for non-heart-related conditions, 23,763 (0.8%) developed A-Fib.
The risk of hospitalization for heart failure for both groups of patients increased regardless of whether or not the surgery was for a heart condition. (Increased by a third and doubled, respectively.)
Risks of Post-Operative A-Fib
Occurrence rates of POAF are difficult to generalize as they vary by the type of surgery. It’s been estimated that Post-Operative A-Fib (POAF) occurs in as high as 64% of patients undergoing heart surgery (and from a low of 0.4% to a high of 26% of patients undergoing non-cardiac surgery.
Evidence is emerging that Post-Operative A-Fib is linked to longer term problems such as stroke and death from any cause and increased risk of hospitalization for heart failure. And may require more aggressive treatments for other risk factors such as high blood pressure, diabetes and narrowing of the arteries.
Editor’s Comments
These findings add to a growing body of literature suggesting that POAF is not just a transient response to surgery.
Post-Operative A-Fib and Heart Failure: The most disturbing point of this study is that post-operative A-Fib is linked to an increased risk of hospitalization for heart failure.
Insist on Use of Protocols: Anyone having surgery should make sure their surgeon knows about and uses protocols to prevent A-Fib after their surgery. They should insist on pre-op treatment.
It’s a shame that most surgeons don’t know about or use these protocols, it’s so simple to do.
To learn about pre-op treatments, go to my post, Having Surgery? Post-Operative A-Fib & Protocols to Prevent it.
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