Abstract 3522: The Impact of Atrial Fibrillation on the Long-Term Results of Patients Following Surgical Revascularization for Ischemic Cardiomyopathy
Objective: The impact of atrial fibrillation (AF) on the long-term outcome of patients suffering from severe ischemic cardiomyopathy (ICM) following surgical revascularization is not well defined.
Methods: We retrospectively reviewed the course of 3202 consecutive patients (pts) suffering from ischemic cardiomyopathy (ICM), defined as global (left ventricular ejection fraction (LVEF) < 30%) and regional wall motion abnormalties following surgical revascularization between 01.01.1988 and 31.12.2005. We divided the pts into two groups according to their heart rhythm at the time of operation. Group1 consists of 846 pts with AF, group 2 of 2356 pts with sinus or pacer rhythms. We compared pre-, perioperative and follow-up data (mean follow-up time 114 months) of both groups. Discrete variables were analysed by means of a chi-square test, continuous variables with a Student’s t-test, a proportional-hazards model was constructed to analyse the impact of each variable on survival. Survival was analysed by means of a Kaplan-Meier model.
Results: Baseline variables (LVEF, no. of bypass grafts, operative data, use of IABP etc) were not significantly different in both groups. 30 d mortality was 2.1 % in both groups, survival at 1 ,5 and 10 years was 93, 76 and 50% in group 1 and 94,80 and 61% in group 2, respectively. Recurrent heart failure occured in 330 pts (39%) in group 1 and 731 (31%) in group 2 (p=0.002) during follow-up. NYHA classes were 1.84(+-0.7) (group 1) and 1.84 (+-0.65) (group 2) at 1 year, at 5 years 2. 6(+-1.1) (group 1) and 2.1 (+-1.1) (group 2) and 2. 8(+-1.6) (group 1) and 2.3 (+-1.0) at ten years. The number of hospital admissions per year were 2.1(+-0.72) in group 1 and 1.7(+-0.66) in group 2.
Conclusions: In pts suffering from ICM with markedly reduced left ventricular function AF has a major impact on the short- and long-term results in respect to survival and recurrent heart failure following surgical revascularization as well as NYHA classes. The differences were not significant at one year but reached statistical significance after 5 years. Furthermore the type of heart rhythm has a major impact on health care costs. These findings caused us to treat AF agressively in recent years in this subset of pts.