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Hosp Pract (1995). 2015;43(4):235-44. doi: 10.1080/21548331.2015.1096181.

Postoperative atrial fibrillation in patients undergoing non-cardiac non-thoracic surgery: A practical approach for the hospitalist.

Author information

1
a 1 Department of General Internal Medicine, Baystate Medical Center, Tufts University School of Medicine , Springfield, MA, USA.
2
b 2 Department of Medicine, Baystate Internal Medicine Residency Program, ACGME-accredited affiliate of Tufts University School of Medicine , Springfield, MA, USA.
3
c 3 Department of Cardiology, Baystate Medical Center, Tufts University School of Medicine , Springfield, MA, USA.
4
d 4 Center for Quality of Care Research, Baystate Medical Center , Springfield, MA, USA.
5
e 5 Tufts Clinical and Translational Science Institute and Tufts University School of Medicine , Springfield, MA, USA.

Abstract

New postoperative atrial fibrillation (POAF) is the most common perioperative arrhythmia and its reported incidence ranges from 0.4 to 26% in patients undergoing non-cardiac non-thoracic surgery. The incidence varies according to patient characteristics such as age, presence of structural heart disease and other co-morbidities, as well as the type of surgery performed. POAF occurs as a consequence of adrenergic stimulation, systemic inflammation, or autonomic activation in the intra or postoperative period (e.g. due to pain, hypotension, infection) in the setting of a susceptible myocardium and other predisposing factors (e.g. electrolyte abnormalities). POAF develops between day 1 and day 4 post-surgery and it is often considered a self-limited entity. Its acute management involves many of the same strategies used in non-surgical patients but the optimal long-term management is challenging because of the limited available evidence. Several studies have shown an association between occurrence of POAF and in-hospital morbidity, mortality, and length of stay. Although, traditionally, POAF was considered to have a generally favorable long-term prognosis, recent data have shown an association with an increased risk of stroke at 1 year after hospitalization. It is unknown, however, whether strategies to prevent POAF or for rate/rhythm control when it does occur, lead to a reduction in morbidity or mortality. This suggests the need for future studies to better understand the risks associated with POAF and to determine optimal strategies to minimize long-term thromboembolic risks. In this article, we summarize the current knowledge on epidemiology, pathophysiology, and short- and long-term management of POAF after non-cardiac non-thoracic surgery with the goal of providing a practical approach to managing these patients for the non-cardiologist clinician.

KEYWORDS:

Atrial fibrillation; epidemiology; long-term prognosis; management of atrial fibrillation; non-cardiac surgery; perioperative; postoperative; risk factors; short-term prognosis

PMID:
26414594
PMCID:
PMC4724415
DOI:
10.1080/21548331.2015.1096181
[Indexed for MEDLINE]
Free PMC Article

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