Postoperative Atrial Fibrillation Understanding Causes and Risks

Abstract

Atrial fibrillation (AF) is a common complication after surgery. It is reported to occur in 25-40% of patients who undergo cardiac surgery [1-3] and it is less common in non-cardiac surgery ones [4,5]. POAF is associated with increased length of hospital stay, higher rates of complications and mortality. Strategies to reduce POAF has been tested with beta-blockers and amiodarone diminishing the incidence of POAF. When POAF occurs, the treatment is mainly based on studies of patients undergoing cardiac surgery, with less evidence in the non-cardiac surgery. The strategies of rate or rhythm control has been tested in a randomized trial [2], and the aim of rhythm control therapy is to improve AF-related symptoms in POAF. Observational trials show that POAF is associated with an increased early stroke risk, increased morbidity and short and long term mortality [3, 5-7], after cardiac and non-cardiac surgery. Additional data is needed to determine the benefits and risks fo long-term anticoagulation and whether or not acute postoperative AF (< 48 hours) carry similar risks in comparison to long term AF (> 48 hours)