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INTRODUCTION

Postoperative atrial fibrillation (POAF) is the most common sustained arrhythmia after cardiac surgeries (valve surgeries more commonly than coronary artery bypass grafts), thoracic surgeries (most commonly pulmonary and esophageal surgery), and non cardiothoracic surgeries. POAF is a supraventricular tachyarrhythmia leading to ineffective atrial contractility that is newly diagnosed in the postoperative setting. Most of the literature on POAF pertains to cardiothoracic surgeries. Atrial fibrillation (AF) has conventionally been described using the duration of the episode, symptoms, or presence of valvular disease (Table 37-1).1,2

TABLE 37-1Definitions of Atrial Fibrillation Based on Duration, Symptoms, and Presence of Valvular Disease

CLINICAL PRESENTATION

Although the exact etiology of POAF is not established, the proposed predictors for POAF have included patient-related factors and surgery-related factors (Table 37-2).1,3–6

TABLE 37-2Predictors and Triggers for Atrial Fibrillation

Patients with AF may be asymptomatic or have symptoms ranging from fatigue, palpitations, dizziness, syncope, or worsening of cardiac disease such as heart failure.7 In patients with mitral stenosis or diastolic dysfunction, AF may lead to hypotension due to the effect on ventricular filling.

PREVENTION OF POAF

There are no guideline-directed pharmacological strategies for prevention of POAF for non cardiothoracic surgeries, except that patients who are on beta-blockers or non dihydropyridine calcium channel blockers should continue these medications in the perioperative period if the blood pressure and heart rate allow.

For patients undergoing cardiothoracic surgeries, there is evidence for preoperative initiation of beta-blockers, diltiazem, amiodarone, or sotalol.1,4,8 The ...

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