Predictors and impact of postoperative atrial fibrillation following thoracic surgery: a state‐of‐the‐art review

Abstract

Summary This review of 19 studies (39,783 patients) of atrial fibrillation after thoracic surgery addresses the pathophysiology, incidence, and consequences of atrial fibrillation in this population, as well as its prevention and management. Interestingly, atrial fibrillation was most often identified in patients not previously known to have the disease. Rhythm control with amiodarone was the most commonly used treatment and nearly all patients were discharged in sinus rhythm. Major predictors were age; male sex; history of atrial fibrillation; congestive heart failure; left atrial enlargement; elevated brain natriuretic peptide level; and the invasiveness of procedures. Overall, patients with atrial fibrillation stayed 3 days longer in hospital. We also discuss the importance of standardising research on this subject and provide recommendations that might mitigate the impact postoperative atrial fibrillation on hospital resources.

Designing Microneedle Patch for Prophylaxis of Postoperative Atrial Fibrillation

“…Postoperative atrial fibrillation (POAF) is the most common arrhythmic complication that occurs in 10–60% of patients following cardiothoracic surgery. , Most POAF cases arise in 30 postoperative days with a peak episode at the first 2–3 days. , It raises the risks of ventricular arrhythmias, acute cardiac failure, and thromboembolic complications and simultaneously increases hospitalization duration and healthcare resource usage. Amiodarone, a class III antiarrhythmic medicine, is demonstrated probably the most effective for the prophylaxis and treatment of POAF but reserves as a second-line drug in clinical practice. − Clinical data show that oral administration of amiodarone has several disadvantages including delayed attainment of therapeutic atrial levels, interaction with many other drugs, and most importantly, potentially serious systemic adverse effects, such as corneal microdeposits (>90%), photosensitivity (25–75%), pulmonary toxicity (1–17%), bluish skin discoloration (4–9%), hepatic toxicity (elevated enzyme levels, 15–30%), and hypothyroidism (6%). − This is mainly attributed to the high accumulation and wide distribution of amiodarone in off-target tissues, as well as its long elimination half-life .…”

“…Postoperative atrial fibrillation (POAF) is the most common arrhythmic complication that occurs in 10−60% of patients following cardiothoracic surgery. 1,2 Most POAF cases arise in 30 postoperative days with a peak episode at the first 2−3 days. 3,4 It raises the risks of ventricular arrhythmias, acute cardiac failure, and thromboembolic complications and simultaneously increases hospitalization duration and healthcare resource usage.…”