Diagnosis and Treatment of New-Onset Perioperative Atrial Fibrillation

Abstract

This article reviews medical and surgical risk factors for developing atrial fibrillation (AF), the most common sustained dysrhythmia in the United States. Evidence for assessment and management of patients with AF, including AF newly identified in the preoperative clinic, immediately preoperatively, intraoperatively, and unstable AF, is presented. A stepwise approach to guide anesthetic decision-making in the assessment of newly identified preoperative AF is proposed. Anesthetic considerations, including the potential impacts of anesthetic and vasopressor selection, and current evidence related to rate control and rhythm control via pharmacologic or electrical cardioversion as well as anticoagulation strategies are discussed.

Keywords: Antiarrhythmic; Cardioversion; Case cancellation; Defibrillation; Dysrhythmia; Paroxysmal atrial fibrillation; Postoperative atrial fibrillation; Silent atrial fibrillation.