Open Access

ARTICLE

Evaluation of Post-Operative Atrial Fibrillation after Cardiac Surgery for Adult Congenital Heart Disease

by Jonathan S. Taylor-Fishwick^1,*, Nicholas Holzemer², Brandon Middlemist³, Vivian Duarte³, Kaitlin E. Olson⁴, Johannes C. von Alvensleben⁵, Megan SooHoo⁶, Amber Khanna⁷

1Internal Medicine-Pediatrics Residency, University of Colorado, Aurora, CO 80045, USA
2 Adult Congenital Heart Disease Fellowship, University of Colorado, Aurora, CO 80045, USA
3 School of Medicine, University of Colorado, Aurora, CO 80045, USA
4 Department of Pediatrics, University of Colorado, Aurora, CO 80045, USA
5 Division of Pediatric Cardiology, Electrophysiology, University of Colorado, Aurora, CO 80045, USA
6 Division of Pediatric Cardiology, University of Colorado, Aurora, CO 80045, USA
7 Division of Cardiology, University of Colorado, Aurora, CO 80045, USA

* Corresponding Author: Jonathan S. Taylor-Fishwick. Email:

Congenital Heart Disease 2024, 19(5), 457-472. https://doi.org/10.32604/chd.2024.057151

Received 09 August 2024; Accepted 29 September 2024; Issue published 31 December 2024

Abstract

Background: Post-operative atrial fibrillation (POAF) frequently occurs after cardiac surgery. Although adult congenital heart disease (ACHD) patients have higher rates of arrhythmia than the general population, there is scant literature on POAF in ACHD patients. Objectives: Identify key risk factors associated with post-operative atrial fibrillation and evaluate the short- and mid-term significance of developing POAF. Methods: A retrospective cohort study was conducted of ACHD patients from 2013–2021 at the University of Colorado Hospital and Children’s Hospital of Colorado. The institutional Society of Thoracic Surgeons (STS) surgical registry was used to identify patients ≥18-year-old with congenital heart disease who underwent cardiac surgery during the study period. Results: A total of 168 patients (48% female) were included. The median age was 36 years (IQR 28–48). One-hundred and fifty patients (90%) had moderate ACHD anatomical complexity, and 10 patients (6%) had severe ACHD anatomical complexity based on initial ACHD diagnosis. POAF occurred in 40 (24%) patients. Older age, history of supraventricular tachycardia, intra-operative arrhythmia, and post-operative hypokalemia independently predicted POAF. POAF was associated with an increased length of stay (8 vs. 5 days, p < 0.001) and recurrence of atrial fibrillation (46% vs. 21%, OR 3.35, p = 0.002) but did not predict mortality, stroke, or bleeding event. Conclusion: Atrial fibrillation is a common complication after cardiac surgery in the ACHD population. Older age, history of supraventricular tachycardia, intra-operative arrhythmia, and post-operative hypokalemia independently predicted POAF. Further investigation is needed to understand the long-term impacts of POAF.

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