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Review
. 2023 Mar 21;44(12):1020-1039.
doi: 10.1093/eurheartj/ehad019.

Postoperative atrial fibrillation: from mechanisms to treatment

Mario Gaudino  1 , Antonino Di Franco  1 , Lisa Q Rong  2 , Jonathan Piccini  3 , Michael Mack  4
Affiliations
Review

Postoperative atrial fibrillation: from mechanisms to treatment

Mario Gaudino et al. Eur Heart J. .

Abstract

Postoperative atrial fibrillation (POAF) is the most common type of secondary atrial fibrillation (AF) and despite progress in prevention and treatment, remains an important clinical problem for patients undergoing a variety of surgical procedures, and in particular cardiac surgery. POAF significantly increases the duration of postoperative hospital stay, hospital costs, and the risk of recurrent AF in the years after surgery; moreover, POAF has been associated with a variety of adverse cardiovascular events (including stroke, heart failure, and mortality), although it is still unclear if this is due to causal relation or simple association. New data have recently emerged on the pathophysiology of POAF, and new preventive and therapeutic strategies have been proposed and tested in randomized trials. This review summarizes the current evidence on the pathogenesis, incidence, prevention, and treatment of POAF and highlights future directions for clinical research.

Keywords: Mechanisms; Postoperative atrial fibrillation; Treatment.

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Conflict of interest statement

Conflict of interest: Dr. Gaudino receives grant funding from the National Institutes of Health and the Canadian Institutes for Health and Research. Dr Di Franco has consulted for Servier, Novo Nordisk, and is an Advisory Board Member for Scharper. Michael Mack is a member of Steering Committee for AbbVie POAF Trial and Senior Vice President of CTSN Network. The other authors have no disclosures.

Figures

Graphical Abstract
Graphical Abstract
Summary of the epidemiology, pathophysiology, associated clinical events, prevention, and treatment strategies for postoperative atrial fibrillation.
Figure 1
Figure 1
Number of articles on POAF published each year between 1960 and 2021.
Figure 2
Figure 2
Summary of the main pathophysiological mechanisms underlying POAF.
Figure 3
Figure 3
Overlap in risk factors for POAF following cardiac vs. non-cardiac surgery.
Figure 4
Figure 4
Association between POAF and adverse cardiovascular outcomes. Available evidence shows that POAF is strongly associated with increased rates of adverse cardiovascular outcomes; nevertheless, POAF is also an early predictor of development of non-surgical atrial fibrillation in the years after surgery, which may be the mediator of this association.
See this image and copyright information in PMC

References

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