Postoperative atrial fibrillation

# Overview
Post-operative atrial fibrillation is common in cardiac or non-cardiac surgeries. The incidence of atrial fibrillation in post-coronary artery bypass surgery (CABG) and non-cardiac surgery patients are 20%-50% and 0.4%-12%, respectively. pain and inflammation due to surgery, hypovolemia and hypervolemia, anemia, hypoxemia, hypomagnesemia and hypokalemia are some of the known factors in pathogenesis of atrial fibrillation after surgery. Although atrial fibrillation can develop within any time after surgery, it's incidence is higher between second and fifth postoperative day. Advanced age, male gender, obesity, history of chronic obstructive pulmonary disease, valvular heart disease and chronic renal failure are some of the risk factors of post operative atrial fibrillation. To address post operative atrial fibrillation there are both pharmacological and non-pharmacological treatments. In hemodynamically unstable patients, AV nodal blocking agents such as short-acting beta-blockers, nondihydropyridine CCBs or intravenous amiodarone have been shown to improve hemodynamics in patients with post-operative atrial fibrillation. Based on a study, using intravenous analgesics in patients who has pulmonary resection surgery showed significantly lower rates of postoperative atrial fibrillation, compared to the control group.

# Postoperative Atrial fibrillation
- Post-operative atrial fibrillation is common in cardiac or non-cardiac surgeries.
- The incidence of atrial fibrillation in post-coronary artery bypass surgery (CABG) patients is between 20% and 50%.
- The incidence of atrial fibrillation after non-cardiac surgeries is between 0.4% and 12%.
- The following algorithm is a summary of post-operative atrial fibrillation pathophysiology:
- Atrial fibrillation can develop within any time after surgery. Nevertheless it's incidence is higher between second and fifth postoperative day.
- The following are some of the general risk factors of post-operative atrial fibrillation:
Advanced age
Male patients
Obesity
Pericarditis
History of chronic obstructive pulmonary disease (COPD)
Valvular heart disease
Left atrial enlargement
Peri-operative heart failure
Discontinuation of either beta blocker or ACE inhibitors before or after surgery
Elevated postoperative adrenergic tone
Chronic renal failure
- Advanced age
- Male patients
- Obesity
- Pericarditis
- History of chronic obstructive pulmonary disease (COPD)
- Valvular heart disease
- Left atrial enlargement
- Peri-operative heart failure
- Discontinuation of either beta blocker or ACE inhibitors before or after surgery
- Elevated postoperative adrenergic tone
- Chronic renal failure
- The following are some of the known risk factors of atrial fibrillation development after non-cardiac surgeries:
Asthma
History of valvular heart disease
Specific procedures, such as abdominal surgeries and extensive vascular surgery
Intraoperative hypotension
- Asthma
- History of valvular heart disease
- Specific procedures, such as abdominal surgeries and extensive vascular surgery
- Intraoperative hypotension
- Paroxysmal form of atrial fibrillation is common post-operatively and is usually self-limiting with sinus rhythm resuming by 6-8 weeks post-surgery in more than 90% of patients.
- Although in many cases post-operative atrial fibrillation is self limiting, the following conditions are considered as well known complications of post-operative atrial fibrillation:
Shock
Stroke
Perioperative myocardial infarction
Heart failure
Ventricular arrhythmias
Longer period of hospitalization
Death
- Shock
- Stroke
- Perioperative myocardial infarction
- Heart failure
- Ventricular arrhythmias
- Longer period of hospitalization
- Death
- Pre-treatment with either digoxin or verapamil has not shown to prevent postoperative atrial fibrillation.
- In hemodynamically unstable patients, AV nodal blocking agents such as short-acting beta-blockers, nondihydropyridine CCBs or intravenous amiodarone have been shown to improve hemodynamics in patients with post-operative atrial fibrillation.
- Based on a study, using intravenous analgesics in patients who has pulmonary resection surgery showed significantly lower rates of postoperative atrial fibrillation, compared to the control group.
- Post-coronary artery bypass surgery (CABG), there is an increased risk of stroke; hence, heparin or oral anticoagulation may be appropriate if post-operative atrial fibrillation persists for longer than 48 hours.

## 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)

## Postoperative Cardiac and Thoracic Surgery

# 2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial                     Fibrillation (DO NOT EDIT)

## Postoperative AF (DO NOT EDIT)