Postoperative atrial fibrillation

Abstract

Postoperative atrial fibrillation (POAF) is the most common complication following cardiac surgery, occurring in 30-60% of patients, usually at 2 to 4 days after surgery. POAF is associated with an increased risk of mortality and morbidity due to stroke and heart failure. Perioperative risk factors for POAF have previously been described. Recently, new risk factors for POAF related to metabolic syndrome have been identified. POAF can be effectively prevented by administration of beta-blockers, amiodarone, statins, steroids or through the use of pacing or off-pump coronary artery bypass grafting. Beta-blockers and amiodarone are particularly effective and are recommended by guidelines, but their use requires caution due to drug-related adverse effects. Otherwise, perioperative prophylactic treatment with statins seems to be effective for prevention of POAF and is associated with a low incidence of adverse effects. The treatment of POAF includes rhythm control, rate control, and/or anticoagulant therapy. When POAF occurs in hemodynamically unstable patients, immediate electrical cardioversion must be performed. For those who are hemodynamically stable, an atrioventricular nodal blocking agent should be used to achieve rate control. If POAF does not convert to sinus rhythm within 24 hours, anticoagulation should be initiated, and a rate control strategy should be implemented.