Seminars in Cardiothoracic and Vascular Anesthesia

 

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Seminars in Cardiothoracic and Vascular Anesthesia, Vol. 8, No. 3, 175-183 (2004)
DOI: 10.1177/108925320400800302

Atrial Fibrillation After Cardiac Surgery: Pathophysiology and Treatment

Christopher A. Palin, MB BS

Rajagopal Kailasam, MB BS

Division of Cardiothoracic Anesthesia, Department of Anesthesiology, Washington University School of Medicine, St Louis, MO

Charles W. Hogue, Jr, MD

Division of Cardiothoracic Anesthesia, Department of Anesthesiology, Washington University School of Medicine, St Louis, MO; Campus Box 8054, 660 S. Euclid Avenue, St Louis, MO 63110-1093; hoguec{at}wustl.edu

Atrial fibrillation (AF) occurs in 25% to 60% of patients after cardiac surgery. It is most consistently associated with advanced age and valvular heart operations. Despite improving knowledge of the pathophysiology of chronic AF, postoperative AF remains an obstinate clinical problem. It is associated with an increased risk of stroke, longer hospital stay, and higher hospital expenditure. Consequently, there has been great interest in strategies to prevent and treat this arrhythmia. Treatment for postoperative AF may require immediate electrical cardioversion for hemodynamically unstable patients. Heart rate control is useful in most patients, with anticoagulation considered after 48 hours. Antiarrhythmic therapy is often effective in restoring sinus rhythm but its use needs to be balanced against the patient's risk of proarrhythmic side effects such as torsade de pointes.


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