Long-term outcomes of postoperative atrial fibrillation after cardiac surgery: Results from 19,000 patients

Xander Jacquemyn; Irsa Hasan; Takuya Ogami; Danny Chu; Derek Serna-Gallegos; Johannes Bonatti; David J Kaczorowski; Mohamed Abdullah; Ibrahim Sultan

doi:10.1016/j.jtcvs.2026.05.005

Long-term outcomes of postoperative atrial fibrillation after cardiac surgery: Results from 19,000 patients

J Thorac Cardiovasc Surg. 2026 May 18:S0022-5223(26)00988-8. doi: 10.1016/j.jtcvs.2026.05.005. Online ahead of print.

Authors

Xander Jacquemyn¹, Irsa Hasan¹, Takuya Ogami¹, Danny Chu¹, Derek Serna-Gallegos¹, Johannes Bonatti¹, David J Kaczorowski¹, Mohamed Abdullah¹, Ibrahim Sultan²

Affiliations

¹ Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
² Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa. Electronic address: sultani@upmc.edu.

PMID: 42155849
DOI: 10.1016/j.jtcvs.2026.05.005

Abstract

Background: Postoperative atrial fibrillation (POAF) is the most common complication following cardiac surgery, yet contemporary procedure-specific data on its incidence, temporal trends, and long-term prognostic impact are limited.

Methods: We conducted a retrospective cohort study of consecutive adult patients undergoing cardiac surgery between January 2010 and April 2024 at a single quaternary referral center. Patients with prior atrial fibrillation, concomitant maze procedures, or death within 30 days were excluded. POAF was defined as any new-onset AF during the index hospitalization up to 30 days. Outcomes were assessed using multivariable Cox regression, restricted mean survival time (RMST), with adjustment for demographic, clinical, and procedural covariates.

Results: A total of 19,316 patients undergoing cardiac surgery, including isolated coronary artery bypass grafting (CABG), valve surgery, aortic surgery, or multicomponent procedures were included. POAF occurred in 6333 patients (32.8%). Incidence varied by procedure: combined CABG and valve 48.0%, CABG and aortic 46.3%, isolated valve 36.9% to 37.0%, and isolated CABG 29.4%. Overall POAF incidence declined by 3.7% annually (95% CI, 2.9%-4.5%). After adjustment, POAF was associated with reduced long-term survival (ΔRMST 0.45 years lost over 10 years; 95% CI, 0.36-0.55), greatest in multicomponent procedures (0.64 years lost) and CABG (0.47 years lost). POAF was also associated with higher heart failure hospitalization at 10 years (absolute difference, 5.8%; 95% CI, 4.1%-7.5%) but not with stroke in competing risk models.

Conclusions: Although the incidence of POAF has declined over time, it remains common and is associated with significant long-term adverse outcomes, including reduced survival and increased heart failure hospitalization.

Keywords: cardiac surgery; coronary artery bypass grafting; long-term outcomes; postoperative atrial fibrillation; valve surgery.