Enhanced Monitoring for Atrial Fibrillation Following Cardiac Surgery - SEARCH-AF

Nov 16, 2020
Font Size
A
A
A
Author/Summarized by Author:
Anthony A. Bavry, MD, MPH, FACC
Summary Reviewer:
Kim A. Eagle, MD, MACC
Date Presented:
11/16/2020
Date Updated:
11/16/2020
Original Posted Date:
11/16/2020
References

Contribution To Literature:

The SEARCH-AF trial showed that enhanced cardiac rhythm monitoring was superior to usual care at detecting postoperative atrial fibrillation.

Description:

The goal of the trial was to evaluate enhanced cardiac rhythm monitoring compared with usual care among post-cardiac surgical patients.

Study Design

  • Randomized
  • Parallel
  • Open-label

Patients who underwent cardiac surgery and were in sinus rhythm at the time of discharge were randomized to enhanced cardiac rhythm monitoring (n = 163) versus usual care (n = 173).

  • Total number of enrollees: 336
  • Duration of follow-up: 9 months
  • Mean patient age: 68 years
  • Percentage female: 22%
  • Percentage with diabetes: 55%

Inclusion criteria:

  • Coronary artery bypass grafting (CABG) or valve repair/replacement ± CABG
  • Sinus rhythm at the time of randomization
  • No plan for oral anticoagulation at discharge
  • CHA2DS2-VASc score ≥4 or ≥2 with at least one of the following: chronic obstructive pulmonary disease, sleep apnea, estimated glomerular filtration rate <60 ml/min/1.73 m2, ≥ mild left atrial dilatation, body mass index ≥30 kg/m2

Exclusion criteria:

  • History of atrial fibrillation/flutter
  • Atrial fibrillation/flutter ≥24 hours postoperatively
  • Mechanical heart valve
  • Hospitalization ≥10 days
  • Received ≥5 g of amiodarone

Other salient features/characteristics:

  • CABG only: 76%
  • Valve repair or replacement: 10%
  • CABG and valve surgery: 14%
  • Median CHA2DS2-VASc score: 4

Principal Findings:

The primary outcome, incidence of atrial fibrillation/flutter duration ≥6 minutes or documentation of atrial fibrillation/flutter by a 12-lead electrocardiogram (ECG), occurred in 19.6% of the enhanced cardiac rhythm monitoring group compared with 1.7% of the usual care group (p < 0.001). The primary outcome was similar among tested subgroups.

Secondary outcomes:

  • Prescription of oral anticoagulation within 45 days: 4.3% of the enhanced cardiac rhythm monitoring group compared with 2.3% of the usual care group (p = nonsignificant)
  • Death, myocardial infarction, ischemic stroke, or non-central nervous system (CNS) thromboembolism within 45 days: 0.6% of the enhanced cardiac rhythm monitoring group compared with 0.6% of the usual care group (p = nonsignificant)

Interpretation:

Among patients who underwent cardiac surgery and were in sinus rhythm at the time of discharge, enhanced cardiac rhythm monitoring was superior to usual care at detecting atrial fibrillation/flutter. Atrial fibrillation/flutter was detected in one-fifth of patients with enhanced cardiac rhythm monitoring. Enhanced cardiac rhythm monitoring was not associated with an increase in the use of anticoagulation. The frequency of adverse ischemic events was low and similar between treatment groups.

References:

Presented by Dr. Subodh Verma at the American Heart Association Virtual Scientific Sessions, November 16, 2020.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and VHD, Interventions and Structural Heart Disease, Vascular Medicine

Keywords: AHA20, AHA Annual Scientific Sessions, Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Atrial Flutter, Brain Ischemia, Cardiac Surgical Procedures, Coronary Artery Bypass, Dilatation, Electrocardiography, Heart Valve Diseases, Myocardial Infarction, Patient Discharge, Stroke, Thromboembolism


< Back to Listings