title: Postoperative atrial fibrillation in patients undergoing non-cardiac non-thoracic surgery: A practical approach for the hospitalist.
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.
authors.affiliation: a 1 Department of General Internal Medicine, Baystate Medical Center, Tufts University School of Medicine , Springfield, MA, USA.
authors.forename: Kirti K
authors.initials: KK
authors.lastname: Joshi
authors.affiliation: a 1 Department of General Internal Medicine, Baystate Medical Center, Tufts University School of Medicine , Springfield, MA, USA.
authors.forename: Mihaela
authors.initials: M
authors.lastname: Tiru
authors.affiliation: b 2 Department of Medicine, Baystate Internal Medicine Residency Program, ACGME-accredited affiliate of Tufts University School of Medicine , Springfield, MA, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Chin
authors.affiliation: c 3 Department of Cardiology, Baystate Medical Center, Tufts University School of Medicine , Springfield, MA, USA.
authors.forename: Marshal T
authors.initials: MT
authors.lastname: Fox
authors.affiliation: a 1 Department of General Internal Medicine, Baystate Medical Center, Tufts University School of Medicine , Springfield, MA, USA.|d 4 Center for Quality of Care Research, Baystate Medical Center , Springfield, MA, USA.|e 5 Tufts Clinical and Translational Science Institute and Tufts University School of Medicine , Springfield, MA, USA.
authors.forename: Mihaela S
authors.initials: MS
authors.lastname: Stefan
mesh_terms: D000367:Age Factors; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D015897:Comorbidity; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D020445:Hospitalists; D006801:Humans; D015994:Incidence; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000145:classification; D013997:Time Factors
chemical_list: D000889:Anti-Arrhythmia Agents; D005343:Fibrinolytic Agents
keywords: Atrial fibrillation; epidemiology; long-term prognosis; management of atrial fibrillation; non-cardiac surgery; perioperative; postoperative; risk factors; short-term prognosis