The contribution of intermittent handheld electrocardiogram and continuous electrocardiogram monitoring with an implantable loop recorder to detect incident and recurrent atrial fibrillation during 1 year after coronary artery bypass graft surgery: A prospective cohort study

Abstract

Background: Atrial fibrillation (AF) is common after coronary artery bypass graft (CABG) surgery. Objective: To evaluate the incidence and recurrence rate of AF during 1 year after CABG surgery. We also aimed at calculating the AF burden and compare long-term intermittent vs continuous electrocardiogram (ECG) monitoring. Methods: Forty patients scheduled for CABG surgery were equipped with an implantable loop recorder (ILR). After discharge, they carried out handheld ECG 3 times daily during the first 30 postoperative days and during 2 weeks at 3 and 12 months. During hospital stay they were monitored with telemetry. Results: Altogether 27 of 40 (68%) patients were diagnosed with AF, 24 during the first month (21 in-hospital and 3 after discharge) and 3 during months 2–12. Three patients progressed into persistent AF. In addition, 17 patients had AF recurrence, 9 of them after the first 30 days. In patients with paroxysmal AF, the AF burden was low, 0.1% (interquartile range [IQR] 0.02%–0.3%). Patients with AF had higher CHA2DS2-VASc scores than non-AF patients: median 4 (IQR 3–4) and 3 (IQR 2–3.5), respectively, P = .006. The handheld ECG identified 45% (9/20) of the patients with AF episodes identified with continuous ECG monitoring with the ILR after discharge from hospital, P = .001. Conclusions: Patients with AF during the postoperative hospitalization showed a high likelihood of recurrent AF, usually within 30 days. Continuous ECG monitoring with an ILR was superior to the handheld ECG for detecting patients with AF. The AF burden was low.

Keywords

• Atrial fibrillation
• Coronary artery bypass graft surgery
• ECG monitoring
• Implantable loop recorder
• Handheld ECG