title: Postoperative atrial fibrillation following cardiac surgery: a persistent complication.
abstract: Postoperative atrial fibrillation (POAF) is a common, expensive and potentially morbid complication following cardiac surgery. POAF occurs in around 35% of cardiac surgery cases and has a peak incidence on postoperative day 2. Patients who develop POAF incur on average $10 000-$20 000 in additional hospital treatment costs, 12-24 h of prolonged ICU time, and an additional 2 to 5 days in the hospital. POAF has been identified as an independent predictor of numerous adverse outcomes, including a 2- to 4-fold increased risk of stroke, reoperation for bleeding, infection, renal or respiratory failure, cardiac arrest, cerebral complications, need for permanent pacemaker placement, and a 2-fold increase in all-cause 30-day and 6-month mortality. The pathogenesis of POAF is incompletely understood but likely involves interplay between pre-existing physiological components and local and systemic inflammation. POAF is associated with numerous risk factors including advanced age, pre-existing conditions that cause cardiac remodelling and certain non-cardiovascular conditions. Clinical management of POAF includes both prophylactic and therapeutic measures, although the efficacy of many interventions remains in question. This review provides a comprehensive and up-to-date summary of the pathogenesis of POAF, outlines current clinical guidelines for POAF prophylaxis and management, and discusses new avenues for further investigation.
authors.affiliation: Barnes-Jewish Hospital, Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Greenberg
authors.affiliation: Barnes-Jewish Hospital, Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Lancaster
authors.affiliation: Barnes-Jewish Hospital, Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Schuessler
authors.affiliation: Barnes-Jewish Hospital, Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Spencer J
authors.initials: SJ
authors.lastname: Melby
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D003131:Combined Modality Therapy; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000191:economics* / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Cardiac surgery; Inflammation; Oxidative damage; Postoperative atrial fibrillation