近日，德国LMU大学Christian Hagl团队研究了冠状动脉搭桥术后新发心房颤动的长期持续监测。2025年10月9日出版的《美国医学会杂志》发表了这项成果。

冠状动脉旁路移植术（CABG）后新发心房颤动（AF）的发生率和负担尚不清楚。然而，北美指南指出，基于非随机临床研究的证据，对冠状动脉搭桥后新发房颤患者给予60天口服抗凝治疗是合理的，这是一种中等强度的推荐（2a级）。

为了验证冠脉搭桥后一年内新发房颤发生率高于现有文献的假设，并评估房颤负担，研究组在德国2个学术心脏外科中心进行了一项前瞻性多中心队列研究，纳入198例患有3支冠状动脉疾病或左主干疾病且无心律失常史的患者，他们在冠脉搭桥期间接受可插入式心脏监护仪进行长期连续心电图监测。患者于2019年11月至2023年11月入组，随访1年。暴露因素为在CABG期间植入的可插入心脏监测器连续监测一年内检测到心房颤动。主要结局为手术一年内新发房颤的累积发病率。次要结局是房颤负担和临床结局。

研究组共评估1217例患者，排除1008例。在198例入组患者中（173例男性[87.4%]，25例女性[12.6%]，平均年龄66岁[SD， 9]岁），95例患者在冠脉搭桥后一年内出现新发房颤（累计发病率48%；95% CI, 41%-55%）。第一年的中位房颤负担为0.07% （IQR, 0.02%-0.23%）或370分钟。第1 ~ 7天房颤负担中位数为3.65% (IQR, 0.95%-9.09%)；第8 ~ 30天为0.04% (IQR, 0% ~ 1.21%)；第31 ~ 365天为0% (IQR, 0% ~ 0.0003%)，分别对应368、13和0分钟。出院后3例房颤发作时间超过24小时。

研究结果表明，尽管该研究中冠脉搭桥后新发房颤的发生率高于既往报道，但这些患者的房颤负担非常低，特别是在30天后。极低的房颤负担对目前的指南建议提出了质疑，即对于冠状动脉搭桥后新发房颤患者应考虑长期口服抗凝剂。

附：英文原文

Title: Long-Term Continuous Monitoring of New-Onset Atrial Fibrillation After Coronary Artery Bypass Grafting

Author: Florian E. M. Herrmann, Anders Jeppsson, Hristo Kirov, Efstratios I. Charitos, Dana Dacian, Jürgen Brmsen, Steffen Massberg, Sebastian Sadoni, Torsten Doenst, Gerd Juchem, Christian Hagl

Issue&Volume: 2025-10-09

Abstract:

Importance  The incidence and burden of new-onset atrial fibrillation (AF) after coronary artery bypass grafting (CABG) are not known. Nevertheless, North American guidelines state that it is reasonable to administer 60 days of oral anticoagulation to patients with new-onset AF after CABG, a moderate-strength recommendation (class 2a) based on evidence derived from nonrandomized clinical studies.

Objective  To test the hypothesis that the incidence of new-onset AF within the first year after CABG is higher than suggested in the current literature and to assess AF burden.

Design, Setting, and Participants  A prospective, multicenter cohort study in 2 academic cardiac surgery centers in Germany that involved 198 patients with 3-vessel coronary artery disease or left main disease and no history of arrhythmias who received an insertable cardiac monitor during CABG for long-term continuous electrocardiographic monitoring. Patients were enrolled from November 2019 through November 2023 and were followed up for 1 year.

Exposures  Atrial fibrillation detected within a year of continuous monitoring using insertable cardiac monitors implanted during CABG.

Main Outcomes and Measures  Cumulative incidence of new-onset AF within a year of surgery. Secondary outcomes were AF burden and clinical outcomes.

Results  A total of 1217 patients were assessed, and 1008 were excluded. Of the 198 patients enrolled (173 male [87.4%]; 25 female [12.6%]; mean age, 66 [SD, 9] years), 95 patients developed new-onset AF within the first year after CABG (cumulative incidence, 48%; 95% CI, 41%-55%). The median AF burden during the first year was 0.07% (IQR, 0.02%-0.23%) or 370 minutes. The median AF burden on days 1 through 7 was 3.65% (IQR, 0.95%-9.09%); on days 8 through 30, 0.04% (IQR, 0%-1.21%); and on days 31 through 365, 0% (IQR, 0%-0.0003%), corresponding to 368, 13, and 0 minutes, respectively. After discharge, 3 patients had an AF episode longer than 24 hours.

Conclusions and Relevance  Although the incidence of new-onset AF after CABG in this study was higher than previously reported, the AF burden in these patients was very low, especially after 30 days. The very low AF burden questions the current guideline recommendations that long-term oral anticoagulation should be considered in patients with new-onset AF after CABG.

DOI: 10.1001/jama.2025.14891

Source: https://jamanetwork.com/journals/jama/fullarticle/2839710