title: Postoperative atrial fibrillation - what do we really know?
abstract: Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery, occurring in 20% to 60% of patients. Advanced age, history of atrial fibrillation (AF), heart failure, peripheral arterial disease and chronic obstructive pulmonary disease are predictors of POAF. The pathogenesis of AF seems to be multifactorial, and includes electrical and structural remodeling as well as inflammation (a systemic response caused by cardiopulmonary bypass and cardiotomy). Numerous pharmacologic agents can decrease the incidence of POAF. It is also necessary to evaluate an agent's ability to decrease stroke, mortality, length of stay and hospital costs. Currently, the use of beta-blockers with adjunctive amiodarone has been shown to reduce POAF and several of its complications. Two therapeutic choices exist in patients with POAF: rate control and rhythm control. The decision which is more important to target should be based on the symptoms of the individual patient. Unlike in patients with chronic AF, POAF is generally transient, and the risks of anticoagulation may outweigh the benefits. Surgical ablation techniques and ablation devices have progressed considerably. This made the procedures quicker and simpler, and therefore feasible in virtually all clinical contexts. In turn, this has raised the issue of post-ablation arrhythmias. Although relapsing AF is generally addressed conservatively, it may require ablation, frequently transseptal. Further research is needed to identify the predictors of POAF and the most effective pharmacological and invasive methods for the prevention and treatment of POAF.
authors.affiliation: Department of Hypertension, Medical University of Lodz, Lodz, Poland. maciejbanach@aol.co.uk
authors.forename: Maciej
authors.initials: M
authors.lastname: Banach
authors.forename: Antonios
authors.initials: A
authors.lastname: Kourliouros
authors.forename: Kurt M
authors.initials: KM
authors.lastname: Reinhart
authors.forename: Stefano
authors.initials: S
authors.lastname: Benussi
authors.forename: Dimitri P
authors.initials: DP
authors.lastname: Mikhailidis
authors.forename: Marjan
authors.initials: M
authors.lastname: Jahangiri
authors.forename: William L
authors.initials: WL
authors.lastname: Baker
authors.forename: Andrea
authors.initials: A
authors.lastname: Galanti
authors.forename: Jacek
authors.initials: J
authors.lastname: Rysz
authors.forename: John A
authors.initials: JA
authors.lastname: Camm
authors.forename: C Michael
authors.initials: CM
authors.lastname: White
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
mesh_terms: D055011:Ablation Techniques; D000818:Animals; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000503:physiopathology* / Q000517:prevention & control / Q000601:surgery; D001342:Autonomic Nervous System Diseases / Q000150:complications; D005355:Fibrosis; D006325:Heart Atria / Q000473:pathology; D006331:Heart Diseases / Q000150:complications / Q000601:surgery; D006801:Humans; D007249:Inflammation / Q000150:complications; D018384:Oxidative Stress / Q000502:physiology; D011183:Postoperative Complications / Q000188:drug therapy* / Q000503:physiopathology* / Q000517:prevention & control / Q000601:surgery; D012307:Risk Factors; D020257:Ventricular Remodeling / Q000502:physiology