TY - JOUR
T1 - Postoperative atrial fibrillation
T2 - mechanisms, manifestations and management
AU - Dobrev, Dobromir
AU - Aguilar, Martin
AU - Heijman, Jordi
AU - Guichard, Jean-Baptiste
AU - Nattel, Stanley
N1 - Funding Information:
The authors are supported by grants from the German Research Foundation (Do 769/4-1; D.D.), German Center for Cardiovascular Research (D.D.), US NIH (R01-HL131517 and R01-HL136389; D.D.), Canadian Institutes of Health Research (S.N.) and Quebec Heart and Stroke Foundation (S.N.).
Publisher Copyright:
© 2019, Springer Nature Limited.
PY - 2019/7
Y1 - 2019/7
N2 - Postoperative atrial fibrillation (POAF) complicates 20-40% of cardiac surgical procedures and 10-20% of non-cardiac thoracic operations. Typical features include onset at 2-4 days postoperatively, episodes that are often fleeting and a self-limited time course. Associated adverse consequences of POAF include haemodynamic instability, increased risk of stroke, lengthened hospital and intensive care unit stays and greater costs. Underlying mechanisms are incompletely defined but include intraoperative and postoperative phenomena, such as inflammation, sympathetic activation and cardiac ischaemia, that combine to trigger atrial fibrillation, often in the presence of pre-existing factors, making the atria vulnerable to atrial fibrillation induction and maintenance. A better understanding of the underlying mechanisms might enable the identification of new therapeutic targets. POAF can be prevented by targeting autonomic alterations and inflammation. beta-Blocker prophylaxis is the best-established preventive therapy and should be started or continued before cardiac surgery, unless contraindicated. When POAF occurs, rate control usually suffices, and routine rhythm control is unnecessary; rhythm control should be reserved for patients who develop haemodynamic instability or show other indications that rate control alone will be insufficient. In this Review, we summarize the epidemiological and clinical features of POAF, the available pathophysiological evidence from clinical and experimental investigations, the results of prophylactic and therapeutic approaches and the consensus recommendations of various national and international societies.
AB - Postoperative atrial fibrillation (POAF) complicates 20-40% of cardiac surgical procedures and 10-20% of non-cardiac thoracic operations. Typical features include onset at 2-4 days postoperatively, episodes that are often fleeting and a self-limited time course. Associated adverse consequences of POAF include haemodynamic instability, increased risk of stroke, lengthened hospital and intensive care unit stays and greater costs. Underlying mechanisms are incompletely defined but include intraoperative and postoperative phenomena, such as inflammation, sympathetic activation and cardiac ischaemia, that combine to trigger atrial fibrillation, often in the presence of pre-existing factors, making the atria vulnerable to atrial fibrillation induction and maintenance. A better understanding of the underlying mechanisms might enable the identification of new therapeutic targets. POAF can be prevented by targeting autonomic alterations and inflammation. beta-Blocker prophylaxis is the best-established preventive therapy and should be started or continued before cardiac surgery, unless contraindicated. When POAF occurs, rate control usually suffices, and routine rhythm control is unnecessary; rhythm control should be reserved for patients who develop haemodynamic instability or show other indications that rate control alone will be insufficient. In this Review, we summarize the epidemiological and clinical features of POAF, the available pathophysiological evidence from clinical and experimental investigations, the results of prophylactic and therapeutic approaches and the consensus recommendations of various national and international societies.
KW - ARTERY-BYPASS SURGERY
KW - C-REACTIVE PROTEIN
KW - PREOPERATIVE PLASMA-ALDOSTERONE
KW - POLYUNSATURATED FATTY-ACIDS
KW - NONCARDIAC THORACIC-SURGERY
KW - OPEN-HEART-SURGERY
KW - CORONARY-ARTERY
KW - CARDIAC-SURGERY
KW - STERILE PERICARDITIS
KW - NEW-ONSET
U2 - 10.1038/s41569-019-0166-5
DO - 10.1038/s41569-019-0166-5
M3 - (Systematic) Review article
SN - 1759-5002
VL - 16
SP - 417
EP - 436
JO - Nature Reviews Cardiology
JF - Nature Reviews Cardiology
IS - 7
ER -