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Reduced incidence of atrial fibrillation after cardiac surgery by continuous wireless monitoring of oxygen saturation on the normal ward and resultant oxygen therapy for hypoxia

^a Clinic for Cardiovascular Surgery, University Hospital Zurich, Rämistr. 100, Zurich CH-8091, Switzerland
^b Department of Experimental Surgery, University Hospital Zurich, Zurich, Switzerland

Received 8 May 2008; received in revised form 16 August 2008; accepted 18 August 2008.

^_* Corresponding author. Tel.: +41 442551111. (Email: dilek.kisner{at}usz.ch).

Objective: Monitoring of cardiac surgical patients after transfer from the intensive care unit to the normal ward is incomplete. Undetected hypoxia, however, is known to be a risk factor for occurrence of atrial fibrillation. We have utilized Auricall^® for continuous wireless monitoring of oxygen saturation and heart rate until discharge. The object of the study was to analyze if oxygen therapy as a result of Auricall^® alerts of hypoxia can decrease the incidence of postoperative atrial fibrillation. Methods: Auricall^® is a wireless portable pulse oximeter. An alert is generated depending on preset threshold values (heart rate, oxygen saturation). Over a period of 6 months, 119 patients were monitored with the Auricall^® following coronary artery bypass graft and/or valve surgery. Oxygen therapy was started subsequent to an oxygen saturation below 90%. These patients were compared with a cohort of 238 patients from the time period before availability of Auricall^®. The patient characteristics were comparable in both groups. In a retrospective study, the incidence of atrial fibrillation was measured in both groups. Results: The postoperative AF was observed in 22/119 patients (18%) in group I and in 66/238 patients (28%) in group II. This difference between the two groups approached significance (p = 0.056). In the subgroup of patients with coronary artery bypass graft with our without simultaneous valve surgery (n = 312), Auricall^® monitoring resulted in a significantly reduced incidence of atrial fibrillation (14% vs 26%, p = 0.016). Conclusions: Continuous monitoring of oxygen saturation on the normal ward and subsequent oxygen therapy for hypoxia can reduce the incidence of atrial fibrillation in a subgroup of patients after cardiac surgery. Prospective randomized trials are warranted to confirm these data.

Key Words: Auricall • Atrial fibrillation • Oxygen therapy • Wireless monitoring • Cardiac surgery