New-Onset Atrial Fibrillation After Surgery Not Necessarily Transient

By Joe Elia

NEJM Journal Watch

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

New-onset atrial fibrillation after noncardiac surgery indicates a heightened risk for stroke or transient ischemic attack (TIA) in subsequent years, a JAMA study finds.

Researchers did retrospective long-term follow-up (median, 5.4 years) on some 450 patients who had new-onset AF in the first 30 days after noncardiac surgery done under general anesthesia (the “AF group”). The patients’ outcomes were compared with those in another 450 matched patients without AF in the early postsurgical period (the “non-AF group”).

Risk for the primary outcome, a composite of ischemic stroke or TIA, was higher in the AF group. The absolute risk by the 5-year mark was 11% in the AF group versus 6% in the non-AF group.

In secondary outcomes, the AF group showed a higher risk for all-cause death (47% vs. 37%).

The authors write that their findings “support the notion that anticoagulation may warrant consideration in postoperative AF.”