Abstract
Postoperative atrial fibrillation (POAF) complicates 15% to 40% of cardiovascular surgeries. Its incidence progressively increases with aging, reaching 50% in octogenarians. This arrhythmia is usually transient but it increases the risk of embolic stroke, prolonged hospital stay, and cardiovascular mortality. Though many pathophysiological mechanisms are known, POAF prediction is still a hot topic of discussion. Doppler echocardiogram and, lately, strain echocardiography have shown significant capacity to predict POAF. Alterations in oxidative stress, calcium handling, mitochondrial dysfunction, inflammation, fibrosis, and tissue aging are among the mechanisms that predispose patients to the perfect “atrial storm”. Manifestations of these mechanisms have been related to enlarged atria and impaired function, which can be detected prior to surgery. Specific alterations in the atrial reservoir and pump function, as well as atrial dyssynchrony determined by echocardiographic atrial strain, can predict POAF and help to shed light on which patients could benefit from preventive therapy.
Highlights
Arrhythmias cause complications in 15% to 40% of patients during the postoperative period of cardiovascular surgery
We aim to outline important mechanisms involved in Postoperative atrial fibrillation (POAF) development in the cardiac surgery setting and to describe how strain echocardiography can recognize alterations in mechanical deformation of the atria related to proarrhythmic substrates, which could be used to optimize POAF prediction
POAF is a frequent complication after cardiac surgery that can affect a patient’s outcome
Summary
Arrhythmias cause complications in 15% to 40% of patients during the postoperative period of cardiovascular surgery. The incidence of postoperative arrhythmias progressively increases from 18% in patients over 60 years old to 50% in octogenarians [1]. The pathophysiology of these arrhythmias is complex and involves a pre-existing and perioperative substrate. AF incidence ranges from 15% to 40% for different centers around the world [2]. It generally occurs in the first five days after surgery, with the highest incidence found between the second and third days. When patients have sequelae due to arrhythmias, there is a remarkable increase in long-term health costs
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