Atrial fibrillation risk is high following coronary artery bypass grafting and is low but gradually accumulates following percutaneous coronary intervention

1. Coronary artery bypass grafting is associated with a very high risk of early new-onset atrial fibrillation (AF), whereas percutaneous coronary intervention (PCI) carries a much lower but steadily accumulating risk of atrial fibrillation over the subsequent two years.

Evidence Rating Level: 2 (Good)

AF is a common arrhythmia in ischemic heart disease, and new-onset AF after coronary revascularization is linked to stroke and mortality. This prospective, multicenter observational cohort study evaluated the 24-month cumulative incidence of AF after isolated coronary artery bypass grafting (CABG) versus PCI in a real-world population without prior AF. At three tertiary Swedish centers, 246 patients (123 CABG, 123 PCI; mean age 67 years, predominantly male) underwent intensive rhythm surveillance: continuous in-hospital monitoring with daily 12-lead ECG and handheld single-lead ECG recordings three times daily for 30 days, followed by 2-week handheld ECG periods at 3, 12 and 24 months. The primary endpoint was new-onset AF within 24 months. At 30 days, AF incidence was 56% after CABG and 2% after PCI; by 24 months, this increased to 58% and 6%, respectively. AF after CABG occurred almost entirely within the first month, whereas post-PCI AF accumulated more gradually, mainly between 12 and 24 months. Thromboembolic events, myocardial infarction and major bleeding were rare in both groups. Overall, CABG was associated with a high early AF burden, while PCI carried a lower but persistent longer-term AF risk.

Click here to read this study in BMJ Open

Image: PD

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