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Original Articles: Adult Cardiac

Invited Commentary

Associate Professor of Surgery, University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216

(Email: lcreswell{at}surgery.umsmed.edu).

Mariscalco and Engström [1] report that early postoperative atrial fibrillation (AF) is a negative prognostic factor for long-term survival among patients undergoing coronary artery bypass grafting (CABG), but not heart valve surgery. The authors suggest this finding may be caused, at least in part, by patients undergoing CABG having less intensive cardiac rhythm follow-up than their valve surgery counterparts. These results are novel and provocative.

We know from longitudinal studies that AF in the general population is associated with a variety of morbidities, as well as reduced long-term survival. Unfortunately, we have few data regarding the natural history of post-cardiac surgery patients and the persistence or development of cardiac arrhythmias. It is not unreasonable to believe, though, that in the post-cardiac surgery patient, AF may well have similar implications in the long term. Indeed, it is entirely believable that post-cardiac surgery patients are more susceptible to the persistence or development of AF than the general population, and these patients would be very suitable as a target population for more intensive surveillance.

The authors acknowledge several limitations with the present study. We know that none of the patients had AF at the time of the operation, but we do not know of any history of AF or other arrhythmias. Moreover, no data are presented regarding the treatment of patients with early postoperative AF, and obviously, no data are available regarding the treatment of AF or other arrhythmias after discharge from the hospital. We also know that the authors have considered only all-cause mortality, not simply deaths due to cardiac conditions in general, or arrhythmias in particular.

For a variety of reasons, we must be cautious in our interpretation of the findings. It may well be true that early postoperative AF is associated with decreased survival in some post-cardiac surgery patients, but it may also be true that this finding is due to other, unmeasured (and uncontrolled) variables. This report illustrates the need for better longitudinal data collection in post-cardiac surgery patients.

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1. Mariscalco G, Engström KG. Postoperative atrial fibrillation is associated with late mortality after coronary surgery, but not after valvular surgery Ann Thorac Surg 2009;88:1871-1876.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Lawrence L. Creswell Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Creswell, L. L. Search for Related Content PubMed PubMed Citation Articles by Creswell, L. L. Related Collections Coronary disease Valve disease Related Article