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Anesth Analg. 2019 Sep 27. doi: 10.1213/ANE.0000000000004474. [Epub ahead of print]

Atrial Fibrillation: Current Evidence and Management Strategies During the Perioperative Period.

Author information

1
From the Department of Anesthesiology & Perioperative Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania.
2
Department of Anesthesiology, Section on Critical Care Medicine & Wake Forest Center for Biomedical Informatics, and the Critical Injury, Illness, and Recovery Research Center (CIIRRC), Wake Forest School of Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina.
3
Outcomes Research Consortium, Cleveland, Ohio.
4
Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
5
Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
6
Evans Center for Implementation and Improvement Sciences, Department of Medicine and the Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts.
7
Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts.

Abstract

Atrial fibrillation (AF) is the most common arrhythmia in the perioperative period. Previously considered a benign and self-limited entity, recent data suggest that perioperative AF is associated with considerable morbidity and mortality and may predict long-term AF and stroke risk in some patients. Despite known risk factors, AF remains largely unpredictable, especially after noncardiac surgery. As a consequence, strategies to minimize perioperative risk are mostly supportive and include avoiding potential arrhythmogenic triggers and proactively treating patient- and surgery-related factors that might precipitate AF. In addition to managing AF itself, clinicians must also address the hemodynamic perturbations that result from AF to prevent end-organ dysfunction. This review will discuss current evidence with respect to causes, risk factors, and outcomes of patients with AF, and address current controversies in the perioperative setting.

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