Dr. Watson
Clinical question: What is the frequency of atrial fibrillation (AF) recurrence in patients with new-onset AF, detected while hospitalized for a noncardiac medical illness or surgery, that returns to sinus rhythm prior to discharge?
Background: AF is frequently detected for the first time in patients hospitalized for a noncardiac medical illness or surgery and may be considered a provoked and transient phenomenon (rather than a paroxysmal one) in these instances. The frequency of AF recurrence and appropriate medical management in this population is unclear.
Study design: Matched cohort study
Setting: Three academic hospitals in Hamilton, Ontario, Canada
Synopsis: The study screened for hospitalized patients with a first episode of AF detected during a hospitalization for a noncardiac medical illness or surgery who returned to sinus rhythm (either spontaneously or via cardioversion) prior to discharge. Each patient was matched with a control patient of the same sex and within 10 years of their age on their ward. The study results evaluated 278 patients (139 matched pairs) with a mean age of 71 years (standard deviation, 10) and a mean CHA2DS2-VASc score of 3.0 (standard deviation, 1.5). Women represented 41% of participants. Patients were followed for one year with three telephone assessments at one, six, and 12 months, and with 14-day continuous ECG patch monitoring at the one- and six-month assessments. The risk of AF was approximately seven times higher in the new-onset AF group at 33.1% (95% CI, 25.3% to 40.9%) compared to 5.0% (CI, 1.4% to 8.7%) in the control group. While a small observational study, the results suggest that these patients may warrant follow-up and monitoring after discharge to detect paroxysmal AF and treat it appropriately.
Bottom line: In this small observational study of patients who had transient AF detected for the first time during a hospitalization for a noncardiac medical illness or surgery and left the hospital in sinus rhythm, approximately one in three developed recurrent AF within one year.
Citation: McIntyre WF, Vadakken ME, et al. Atrial fibrillation recurrence in patients with transient new-onset atrial fibrillation detected during hospitalization for noncardiac surgery or medical illness: a matched cohort study. Ann Intern Med. 2023;176(10):1299-1307.
Dr. Watson is a hospitalist at Duke University Hospital and a medical instructor in the department of medicine at Duke University School of Medicine in Durham, N.C.