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

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). Onehundred 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. independently predicted POAF. Further investigation is needed to understand the long-term impacts of POAF.