Atrial fibrillation following open heart surgery: long-term incidence and prognosis Jayasree Pillarisetti & Akshar Patel & Sudharani Bommana & Rajeshwer Guda & Jillian Falbe & George Trip Zorn & Gregory Muehlebach & James Vacek & Sue Min Lai & Dhanunjaya Lakkireddy Received: 17 March 2013 /Accepted: 15 August 2013 /Published online: 29 November 2013 # Springer Science+Business Media New York 2013 Abstract Introduction While early postoperative atrial fibrillation (post op AF) following valve and coronary artery bypass surgery is a known common cause of increased morbidity and mortality, the late recurrence of AF long term in this group of patients has not been well studied. Objective The objective of this study was to assess the late recurrence and predictors of AF in patients undergoing open heart surgery. Methods From a prospective cardiovascular surgery registry, 519 patients with no prior history of AF who underwent open heart surgery for cardiac bypass/valvular surgeries between May 2000 and April 2004 were followed until May 2009. A Cox proportional hazards model was used to assess the impact of early post op AF on the long-term AF after adjusting for significant covariates Results Of these patients, 25.6 % (133) had early (0–3 months) post op AF (group A). The remainder of patients were con- sidered as controls (group B, n =386). Late occurrence of AF (3–84 months) was 5.3 % (n =28) after a mean follow up duration of 5±1.9 years. The late occurrence of AF in group A (recurrent AF) was significantly higher than in group B (11 vs 3% n =15 vs 13, p =0.0002). Early postoperative AF was a significant predictor of late recurrence of AF in multivariate analysis (hazard ratio (HR) 3.9, CI 1.8–8.4, p =0.0003). Group A also had higher mortality compared to group B (21 vs 13 %, n =28 vs n =51, p =0.003) with early postoperative AF showing a trend towards higher mortality on multivariate analysis (HR 1.7, p =0.06). Conclusions Late recurrence of AF is higher than was previ- ously thought to be in patients experiencing early post oper- ative AF with a trend towards higher long-term mortality. Post op AF should not be dismissed as a benign entity and these patients should be followed closely. Keywords Atrial fibrillation . Cardiac surgery . Postoperative Abbreviations AF Atrial Fibrillation CABG Coronary Artery Bypass Graft EKG Electrocardiogram Post op AF Postoperative Atrial Fibrillation 1 Introduction Atrial fibrillation (AF) is the most common arrhythmia current- ly affecting 2.3 million people in the United States and is associated with increased risk of stroke, heart failure, and death [1–6]. The risk of AF doubles with each increasing decade of life with a prevalence of 8 % in the general population greater than 75 years of age [1–7]. The National Institute of Health has recognized AF recurrence as a priority area and has called for primary and secondary prevention trials of AF [8]. AF can occur immediately during the post-operative period in patients undergoing open heart surgery and is a well-known J. Pillarisetti : A. Patel : S. Bommana : R. Guda : J. Falbe : G. T. Zorn : G. Muehlebach : J. Vacek : Sue Min Lai : D. Lakkireddy University of Kansas Hospital, Kansas City, KS, USA J. Pillarisetti : A. Patel : S. Bommana : R. Guda : J. Falbe : G. T. Zorn : G. Muehlebach : J. Vacek : Sue Min Lai : D. Lakkireddy Mid America Cardiology Associates, University of Kansas Hospital, Kansas City, KS, USA D. Lakkireddy (*) Center for Excellence in Atrial Fibrillation & EP Research, Bloch Heart Rhythm Center, KU Cardiovascular Research Institute, Mid America Cardiology at University of Kansas Hospitals, 3901 Rainbow Blvd, Kansas City, KS 66196, USA e-mail: dlakkireddy@mac.md J Interv Card Electrophysiol (2014) 39:69–75 DOI 10.1007/s10840-013-9830-6