Skip to main content


Log in

Atrial fibrillation following open heart surgery: long-term incidence and prognosis

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript



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.


The objective of this study was to assess the late recurrence and predictors of AF in patients undergoing open heart surgery.


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


Of these patients, 25.6 % (133) had early (0–3 months) post op AF (group A). The remainder of patients were considered 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).


Late recurrence of AF is higher than was previously thought to be in patients experiencing early post operative 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others



Atrial Fibrillation


Coronary Artery Bypass Graft



Post op AF:

Postoperative Atrial Fibrillation


  1. Psaty, B. M., Manolio, T. A., Kuller, L. H., Kronmal, R. A., Cushman, M., Fried, L. P., et al. (1997). Incidence of and risk factors for atrial fibrillation in older adults. Circulation, 96, 2455–2461.

    Article  CAS  PubMed  Google Scholar 

  2. Lloyd-Jones, D. M., Wang, T. J., Leip, E. P., Larson, M. G., Levy, D., Vasan, R. S., et al. (2004). Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation, 110, 1042–1046.

    Article  PubMed  Google Scholar 

  3. Heeringa, J., Van Der Kuip, D. A., Hofman, A., Kors, J. A., van Herpen, G., Stricker, B. H., et al. (2006). Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. European Heart Journal, 27, 949–953.

    Article  PubMed  Google Scholar 

  4. Wolf, P. A., Dawber, T. R., Thomas, H. E., Jr., & Kannel, W. B. (1978). Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham study. Neurology, 28, 973–977.

    Article  CAS  PubMed  Google Scholar 

  5. Krahn, A. D., Manfreda, J., Tate, R. B., Mathewson, F. A., & Cuddy, T. E. (1995). The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-Up Study. American Journal of Medicine, 98, 476–484.

    Article  CAS  PubMed  Google Scholar 

  6. Benjamin, E. J., Wolf, P. A., D’Agostino, R. B., Silbershatz, H., Kannel, W. B., & Levy, D. (1998). Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation, 98, 946–952.

    Article  CAS  PubMed  Google Scholar 

  7. Kannel, W. B., Wolf, P. A., Benjamin, E. J., & Levy, D. (1998). Prevalence, incidence, prognosis and predisposing conditions for atrial fibrillation: population-based estimates. The American Journal of Cardiology, 82, 2–9.

    Article  Google Scholar 

  8. Benjamin, E. J., Chen, P. S., Bild, D. E., et al. (2009). Prevention of atrial fibrillation: report from an NHLBI workshop. Circulation, 119(4), 606–618.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Mitchell, L. B. (2000). Incidence, timing, and outcome of atrial tachyarrhythmias. In J. S. Steinberg (Ed.), Atrial fibrillation after cardiac surgery (pp. 37–50). Boston, MA: Kluwer Academic Publishers.

    Chapter  Google Scholar 

  10. Andrews, T. C., Reimold, S. C., Berlin, J. A., & Antman, E. M. (1991). Prevention of supraventricular arrhythmias after coronary artery bypass surgery. A meta-analysis of randomized control trials. Circulation., 84, 236–244.

    Google Scholar 

  11. Mathew, J. P., Fontes, M. L., Tudor, I. C., Ramsay, J., Duke, P., Mazer, D. C., et al. (2004). A multicenter risk index for atrial fibrillation after cardiac surgery. Journal of the American Medical Association, 291, 1720–1729.

    Article  CAS  PubMed  Google Scholar 

  12. Crystal, E., Healey, J., & Connolly, S. J. (2003). Atrial fibrillation after cardiac surgery: update on the evidence on the available prophylactic interventions. Cardiac Electrophysiology Review, 7, 189–92.

    Article  PubMed  Google Scholar 

  13. Hilleman, D. E., Hunter, C. B., Mohiuddin, S. M., et al. (2005). Pharmacological management of atrial fibrillation following cardiac surgery. American Journal of Cardiovascular Drugs, 5, 361–9.

    Article  CAS  PubMed  Google Scholar 

  14. Shantsila, E., Watson, T., & Lip, G. Y. (2006). Atrial fibrillation post-cardiac surgery: changing perspectives. Current Medical Research and Opinion, 22, 1437–41.

    Article  CAS  PubMed  Google Scholar 

  15. Ommen, S. R., Odell, J. A., & Stanton, M. S. (1997). Atrial arrhythmias after cardiothoracic surgery. New England Journal of Medicine, 336, 1429–34.

    Article  CAS  PubMed  Google Scholar 

  16. Hogue, C. W., Jr., Creswell, L. L., Gutterman, D. D., et al. (2005). Epidemiology, mechanisms, and risks: American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillation after cardiac surgery. Chest, 128, 9S–16S.

    Article  PubMed  Google Scholar 

  17. Elahi, M., Hadjinikolaou, L., & Galiñanes, M. (2003). Incidence and clinical consequences of atrial fibrillation within 1 year of first-time isolated coronary bypass surgery. Circulation, 108, 207–212.

    Article  Google Scholar 

  18. Ahlsson, A., Fengsrud, E., Bodin, L., & Englund, A. (2010). Postoperative atrial fibrillation in patients undergoing aortocoronary bypass surgery carries an eightfold risk of future atrial fibrillation and a doubled cardiovascular mortality. European Journal of Cardio-Thoracic Surgery, 37(6), 1353–9.

    Article  PubMed  Google Scholar 

  19. Filardo, G., Hamilton, C., Hamman, B., Hebeler, R. F., Jr., Adams, J., & Grayburn, P. (2010). New-onset postoperative atrial fibrillation and long-term survival after aortic valve replacement surgery. The Annals of Thoracic Surgery, 90(2), 474–9.

    Article  PubMed  Google Scholar 

  20. El-Chami, M. F., Kilgo, P., Thourani, V., Lattouf, O. M., Delurgio, D. B., Guyton, R. A., et al. (2010). New-onset atrial fibrillation predicts long-term mortality after coronary artery bypass graft. Journal of the American College of Cardiology, 55(13), 1370–6.

    Article  PubMed  Google Scholar 

  21. Wolf, P. A., Abbott, R. D., & Kannel, W. B. (1991). Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke, 22, 983–988.

    Article  CAS  PubMed  Google Scholar 

  22. Go, A. S., Hylek, E. M., Phillips, K. A., Chang, Y., Henault, L. E., Selby, J. V., et al. (2001). Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. Journal of the American Medical Association, 285(18), 2370–5.

    Article  CAS  PubMed  Google Scholar 

  23. McKeown, P. P., & Gutterman, D. (2005). Executive summary: American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillation after cardiac surgery. Chest, 128, 1S–5S.

    Article  PubMed  Google Scholar 

  24. Melduni, R. M., Suri, R. M., Schaff, H. V., Li, Z., Ammash, N. M., Seward, J. B., & Gersh, B. J. (2009). Abstract 2555: New-onset postoperative atrial fibrillation is an early predictive marker of late AF and long-term mortality following cardiac surgery: a comprehensive population-based study. Circulation, 120, S659–S660.

    Google Scholar 

Download references

Conflict of interests

There are no conflicts of interests for any of the authors relevant to the study.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Dhanunjaya Lakkireddy.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pillarisetti, J., Patel, A., Bommana, S. et al. Atrial fibrillation following open heart surgery: long-term incidence and prognosis. J Interv Card Electrophysiol 39, 69–75 (2014).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: