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The Afib Blind Spot That's Undermining Heart Surgery Outcomes – Especially in CABG

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Why 1 in 5 cardiac surgery patients go undiagnosed

When preparing a patient for Coronary Artery Bypass Graft (CABG) or valve surgery, there's a crucial step that often gets overlooked: screening for atrial fibrillation (Afib). And, overlooking that step can have significant consequences.

A recent analysis involving more than 79,000 patients revealed a critical oversight: 20% of CABG patients had experienced Afib-related hospital admissions within the previous three years—but this diagnosis was unknown at the time of surgical referral.1

That means thousands of patients may be having surgery with undiagnosed Afib, missing opportunities to improve outcomes through early intervention.

The Cost of Missing Afib

Undiagnosed Afib can complicate cardiac surgery and recovery. When it's left unmanaged, Afib increases the risk of stroke,2 prolonged hospital stays3 and repeat procedures.4 Fortunately, it's often detectable before surgery—but only when intentionally looked for.
That's why screening for Afib must be a standard part of the preoperative process for patients undergoing CABG or valve surgery.5

The 5-Minute Screening That Could Change Everything

Start with a thorough chart review - key indicators of previous or suspected Afib include:6

  • History of Holter monitoring
  • Past cardioversion
  • Prior catheter ablation
  • Any documented episodes of irregular rhythm

Beyond the chart, collaborate closely with the referring physician.

  • Review the patient's cardiovascular history for signs of Afib7
  • Determine whether surgical ablation should be part of the operative plan8

And at the point of surgical referral, simple and quick intake questions can help flag potential undiagnosed Afib:9

  • "Have you ever been told you had an irregular heart rhythm?"
  • "Do you experience heart palpitations?"
  • "Have you ever taken blood thinners?"
  • "Have you used medications to control your heart rate?"

These low-effort, high-yield questions can provide essential clues that could trigger further evaluation.10

What Early Detection Unlocks: The Outcomes Payoff

Identifying Afib before cardiac surgery allows for:

  • Proactive rhythm management11
  • Integration of ablation into the surgical plan12
  • Improved long-term outcomes13-14

It's not just about preventing complications—it's about giving patients the best possible chance for a smooth recovery and long-term risk reduction.15

By implementing consistent and systematic Afib screening into standard pre-surgical evaluation where possible, patient outcomes can be significantly improved while reducing preventable complications.16

  1. McCarthy PM, Cox JL, Damiano RJ Jr, et al. Atrial fibrillation in patients undergoing coronary artery bypass grafting: a comprehensive analysis of 79,143 patients from the Society of Thoracic Surgeons National Database. Ann Thorac Surg. 2022;113(6):1929-1936.
  2. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22(8):983-988.
  3. Villareal RP, Hariharan R, Liu BC, et al. Postoperative atrial fibrillation and mortality after coronary artery bypass surgery. J Am Coll Cardiol. 2004;43(5):742-748.
  4. Aranki SF, Shaw DP, Adams DH, et al. Predictors of atrial fibrillation after coronary artery surgery. Current trends and impact on hospital resources. Circulation. 1996;94(3):390-397.
  5. Badhwar V, Rankin JS, Damiano RJ Jr, et al. The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation. Ann Thorac Surg. 2017;103(1):329-341.
  6. January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation. Circulation. 2019;140(2):e125-e151.
  7. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37(38):2893-2962.
  8. Ad N, Damiano RJ Jr, Badhwar V, et al. Expert consensus guidelines: Examining surgical ablation for atrial fibrillation. J Thorac Cardiovasc Surg. 2017;153(6):1330-1354.
  9. Lowres N, Neubeck L, Redfern J, Freedman SB. Screening to identify unknown atrial fibrillation. A systematic review. Thromb Haemost. 2013;110(2):213-222.
  10. Healey JS, Connolly SJ, Gold MR, et al. Subclinical atrial fibrillation and the risk of stroke. N Engl J Med. 2012;366(2):120-129.
  11. Wyse DG, Waldo AL, DiMarco JP, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002;347(23):1825-1833.
  12. Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2017;14(10):e275-e444.
  13. Musharbash FN, Schill MR, Sinn LA, et al. Performance of the Cox-maze IV procedure is associated with improved long-term survival in patients with atrial fibrillation undergoing cardiac surgery. J Thorac Cardiovasc Surg. 2018;155(1):159-170.
  14. Gammie JS, Haddad M, Milford-Beland S, et al. Atrial fibrillation correction surgery: lessons from the Society of Thoracic Surgeons National Cardiac Database. Ann Thorac Surg. 2008;85(3):909-914.
  15. Phan K, Xie A, La Meir M, Black D, Yan TD. Surgical ablation for treatment of atrial fibrillation in cardiac surgery: a cumulative meta-analysis of randomised controlled trials. Heart. 2014;100(9):722-730.
  16. Mehaffey JH, Haywood NS, Hawkins RB, et al. Barriers to atrial fibrillation ablation during mitral valve surgery. J Thorac Cardiovasc Surg. 2021;161(3):1012-1019.
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