Multivessel coronary artery disease as a predictor of prolonged postoperative atrial fibrillation after cardiac surgery

Postoperative atrial fibrillation (POAF) is the most common arrhythmia following cardiac surgery and is associated with prolonged hospitalization, postoperative complications, and increased healthcare burden. Given the potential role of coronary artery disease (CAD) in atrial ischemia and remodeling, CAD burden may contribute to prolonged arrhythmic episodes. Aim: To evaluate whether multivessel coronary artery disease is associated with prolonged postoperative atrial fibrillation (>48 hours) in patients undergoing cardiac surgery. This retrospective study included 378 adult patients with POAF after cardiac surgery at Zan Mitrev Clinic (2020–2023). Only patients with preoperative sinus rhythm and at least one-year follow-up were analyzed. Demographic, clinical, echocardiographic, and angiographic data were extracted from medical records. CAD severity was categorized as one-vessel, two-vessel, or multivessel disease. The duration of postoperative AF was recorded for each patient, allowing comparison of clinical characteristics across different POAF duration patterns. Statistical analysis included Mann–Whitney U test, Chi-square test, and Fisher’s exact test, with p<0.05 considered significant. Across the cohort, POAF episodes varied from short-lasting to sustained arrhythmia exceeding 48 hours. Of the 378 patients, 193 experienced episodes lasting 48 hours or less, while 185 had POAF that persisted beyond 48 hours. No significant differences were found between groups regarding age, BMI, smoking status, hypertension, diabetes, dyslipidemia, COPD, thyroid disease, renal dysfunction, or preoperative echocardiographic indices (all p>0.05). However, CAD severity differed significantly (χ²=8.891; p=0.0308), with multivessel CAD being more prevalent in patients with prolonged POAF (57.8% vs. 48.2%). Multivessel CAD is significantly associated with prolonged POAF duration. Incorporating CAD burden into perioperative risk assessment may enhance identification of patients at risk for sustained arrhythmia and guide targeted postoperative monitoring. Keywords: Atrial fibrillation, Cardiac surgery, Coronary artery disease, Multivessel disease