Volume 6, Issue 5

Background. Postoperative atrial fibrillation (POAF) is the most common complication of cardiac surgery and is associated with stroke and mortality, yet rhythm monitoring usually ends when telemetry is discontinued or the patient is discharged. We assessed how many additional cases are detected by continuous wearable electrocardiogram (ECG) patch monitoring. Methods. In this prospective cohort study, consecutive adults without previous atrial fibrillation undergoing coronary artery bypass grafting (CABG), valve surgery, or both at a tertiary heart center between March 2024 and February 2025 wore a single-lead ECG patch for 14 days, applied at the end of surgery, in addition to standard care with in-hospital telemetry, daily 12-lead ECGs, and symptom-driven assessment. The primary outcome was atrial fibrillation lasting 30 seconds or longer. Results. Of 412 enrolled patients, 398 (96.6%) had at least 72 hours of analyzable recording (mean age 66.2 ± 9.4 years; 24.6% women). Standard care detected POAF in 112 patients (28.1%), whereas the patch detected it in 151 (37.9%), identifying 39 additional patients (9.8%). In 27 of these 39 patients (69.2%), the first episode occurred after discharge, and 31 (79.5%) were asymptomatic. Episodes lasted 24 hours or longer in 6 patients, and oral anticoagulation was started in 14 (35.9%). Skin irritation occurred in 7.3% of patients. Conclusions. Extended patch monitoring detected POAF in about one in ten patients in whom standard care found none, mostly after discharge and without symptoms. Its effect on anticoagulation decisions and clinical outcomes should be evaluated in randomized trials.