Abstract
Postoperative atrial fibrillation (POAF) is the most common complication following cardiac surgery, tending to occur 2 to 4 days after surgery in 30-60% of patients, with a peak incidence on postoperative day 2. POAF is associated with an increased risk of mortality and morbidity due to stroke and heart failure. Preoperative risk factors for POAF include age, enlargement of the left atrium, and hypertrophy of the left ventricle. Intraoperative risk factors for POAF are associated with extracorporeal circulation. Postoperative risk factors for POAF include hypervolemia, electrolyte imbalance, increased afterload, hypotension, and inflammation. Recently, new risk factors related to metabolic syndrome have been identified. POAF can be effectively prevented by administration of beta-blockers, amiodarone, statins, steroids, pacing, and off-pump coronary artery bypass grafting. Beta-blockers and amiodarone are particularly effective and are recommended by guidelines. The treatment of POAF includes rhythm control, rate control, and anticoagulant therapy. When POAF occurs in hemodynamically unstable patients, immediate electrical cardioversion must be performed. For those who are hemodynamically stable, an AV nodal blocking agent should be used to achieve rate control. If POAF does not convert to a sinus rhythm within 24 hours, anticoagulation measures should be initiated, and a rhythm control strategy should be implemented.
