Impact Of Postoperative Atrial Fibrillation Research Articles

TCT-5 Impact of Postoperative Atrial Fibrillation on Long-Term Outcomes After Isolated Coronary Artery Bypass Grafting

TCT-5 Impact of Postoperative Atrial Fibrillation on Long-Term Outcomes After Isolated Coronary Artery Bypass Grafting

Effects of postoperative atrial fibrillation on cardiac surgery outcomes in Vietnam: a prospective multicenter study

ABSTRACT Background This study was designed to assess the impact of postoperative atrial fibrillation (POAF) on short- and long-term outcomes after cardiac surgery. Methods We prospectively assessed POAF concerning outcomes in 379 adult patients who had undergone cardiac surgery in two heart surgery centers with a follow-up period of one year for every patient. The effects of POAF on postoperative events were evaluated using Logistic regression, Cox regression (adjusted for propensity score), and Kaplan-Meier analysis. Results The incidence of POAF was 27.2%. Multivariable logistic regression analysis revealed POAF was associated with an increased risk of 6-month (OR = 5.36; CI: 1.51–18.94; p = 0.009), and 1-year mortality (OR = 4.56; CI: 1.29–16.04; p = 0.018) as well as Major Adverse Cardiocerebral Events (MACEs; acute MI, cardiac arrest, low cardiac output after surgery, third-degree atrioventricular block or stroke; OR = 3.02; CI: 1.29–7.05; p = 0.011), Intensive Care Unit (ICU) stay > 3 days (OR = 2.39; CI: 1.14–5.00; p = 0.021), and postoperative stay > 14 days (OR = 3.12; CI: 1.65–5.90; p < 0.001). Multivariable Cox regression analysis showed POAF as an independent predictor of mortality at one year (HR = 2.86; CI: 1.05–7.75; p = 0.038). Discharge plans including statin and beta-blocker had an independent association with a reduced mortality at one year (HR = 0.22; CI: 0.05–0.96; p = 0.045; HR = 0.16; CI: 0.03–0.87; p = 0.034, respectively). Conclusions POAF is associated with an increased risk of morbidity, all-cause mortality, and hospital duration. Statins and beta-blockers that were included in discharge plans had an independent association with reduction in 1-year all-cause mortality.

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

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.

Predictors and prognostic impact of post-operative atrial fibrillation in patients with hip fracture surgery.

BACKGROUNDAtrial fibrillation (AF) is the most common arrhythmia developing in post-operative patients. Limited data are available regarding pre-operative risk factors and prognostic impact of post-operative AF (POAF) following hip fracture surgery (HFS) in Korean population. AIMWe aimed to investigate the incidence, predictors, and hospital prognosis of POAF in HFS patients. METHODSThis study included 245 patients without history of AF who underwent HFS between August 2014 and November 2016. POAF was defined as new-onset AF that occurred during hospitalization after HFS. RESULTSTwenty patients (8.2%) experienced POAF after HFS. POAF developed on median post-operative day 2 (interquartile range, 1–3). Multivariable logistic regression analysis showed that age [odds ratio (OR), 1.111; 95% confidence interval (CI), 1.022–1.209], chronic obstructive pulmonary disease (COPD) (OR, 6.352; 95%CI, 1.561–25.841) and E/e’ ratio (OR, 1.174; 95%CI, 1.002–1.376) were significant predictors of POAF. Patients with POAF had a significantly higher intensive care unit admission rate (55.0% vs 14.7%, P < 0.001) and incidence of congestive heart failure (45.0% vs 10.7%, P < 0.001). In multivariable logistic regression analysis, POAF was significantly associated with increased incidence of congestive heart failure (OR, 4.856; 95%CI, 1.437–16.411) and intensive care unit admission (OR, 6.615; 95%CI, 2.112–20.718).CONCLUSIONPOAF was frequently developed in elderly patients following HFS. Age, COPD and elevated E/e’ ratio were found as significant predictors of POAF in HFS patients. Patients with POAF significantly experienced intensive care unit admission and incident congestive heart failure during hospitalization.

The long-term impact of postoperative atrial fibrillation after cardiac surgery

ObjectiveThe literature has reported worse in-hospital outcomes for patients with atrial fibrillation. The objective of the following study is to provide detailed results on the long-term impact of postoperative atrial fibrillation on survival and hospital readmission in cardiac surgery. MethodsAll patients undergoing open cardiac surgery were reviewed with the exclusion of preoperative atrial fibrillation or patients undergoing ventricular assist device, transplant, or Cox-Maze procedures. Propensity matching (1:1) was performed to ensure similar baseline characteristics. Multivariable analysis identified significant associations with mortality and readmission. ResultsA total of 12,227 patients with cardiac disease were divided into 7927 patients (64.8%) without postoperative atrial fibrillation and 4300 patients (35.2%) with new-onset postoperative atrial fibrillation. Propensity matching (1:1) yielded 4275 risk-adjusted pairs. There was no difference between the nonpostoperative atrial fibrillation versus postoperative atrial fibrillation cohorts regarding operative mortality (4.61% vs 4.12%; P = .26) and stroke (2.32% vs 2.76%; P = .191). Patients with postoperative atrial fibrillation had higher rates of reoperation (12.12% vs 6.83%; P < .001), transfusion (43.42% vs 36.94%; P < .001), sepsis (1.99% vs 0.80%; P < .001), prolonged ventilation (15.88% vs 9.24% vs; P < .001), pneumonia (6.60% vs 2.36%; P < .001), renal failure (6.90% vs 3.37%; P < .001), and dialysis (4.94% vs 2.08%; P < .001). The postoperative atrial fibrillation cohort had a significantly higher incidence of atrial fibrillation on follow-up (11.74% vs 4.75%; P < .001). Postoperative atrial fibrillation was independently associated with mortality (hazard ratio, 1.21; 1.12-1.33; P < .001), all-cause readmissions (hazard ratio, 1.05; 1.01-1.1; P = .010), and heart failure–specific readmission (hazard ratio, 1.14; 1.04-1.26; P = .01). ConclusionsPatients in the postoperative atrial fibrillation cohort had worse perioperative morbidity, lower survival, and more readmissions for heart failure on long-term follow-up.

Department of veterans affairs post-coronary artery bypass graft patients’ atrial fibrillation: 10-year outcomes

Aim: This Department of Veterans Affairs’ (VA) research project evaluated the impact of postoperative atrial fibrillation (POAF) upon 10-year outcomes for coronary artery bypass grafting (CABG) patients. Methods: Veterans enrolled in the “Randomized On-/Off-pump Bypass” (ROOBY) trial with new-onset POAF post-CABG were compared to those without POAF with respect to 10-year atrial fibrillation (AF) and mortality rates. Multivariable logistic regression examined whether AF was independently associated with 10-year survival after holding other preoperative risk factors constant. Results: Of the 2203 ROOBY veterans enrolled at 18 VA medical centers from 2002 to 2008, 100 patients with preoperative AF (n = 93) or unknown post-CABG POAF status (n = 7) were excluded. The POAF rate was 26.2% (n = 551/2103). The POAF patients were older and had more co-morbidities than the non-POAF patients (n = 1552). The AF rate among 10-year ROOBY POAF survivors was 18.9% (n = 64/338) compared to 5.8% (n = 61/1048) for non-POAF patients; P &lt; 0.001. Compared to non-POAF patients’ 10-year survival of 70%, the ROOBY POAF veterans’ 10-year survival rate was 63%. Baseline risks inversely associated with 10-year survival included age, chronic obstructive pulmonary disease, serum creatinine &gt; 1.5, peripheral vascular disease, and smoking. Holding these factors constant, POAF was not independently associated with 10-year survival. Conclusion: Post-CABG, ROOBY POAF veterans had higher rates of 10-year AF, which was negatively associated with 10-year survival; however, this association was not significant. Given that POAF may adversely impact 10-year AF rates, additional investigation appears warranted to improve future POAF patients’ care.

Postoperative atrial fibrillation is associated with increased resource utilization after cardiac surgery: a regional analysis of the Southeastern United States

Aim: Postoperative atrial fibrillation (POAF) is a known risk factor for morbidity and mortality following cardiac surgery though contemporary resource utilization data is limited. We hypothesize that POAF increases the length of stay, hospital cost, and discharges to facilities, though this trend may be tempering over time. Methods: Records were extracted for all patients in a regional database who underwent coronary artery bypass grafting, aortic valve replacement, or both (2012-2020). Patients without a history of atrial fibrillation were stratified by POAF for univariate analysis. Patients were propensity-score matched to account for baseline, operative, and postoperative differences. Results: Of the 27,307 cardiac surgery patients, 23% developed POAF. Matching resulted in 5926 well-balanced pairs of patients with and without POAF. Every metric of resource utilization was higher for patients with POAF, including ICU length of stay (58 h vs. 49 h, P &lt; 0.0001), postoperative length of stay (7 days vs. 5 days, P &lt; 0.0001), discharge to a facility (27% vs. 23%, P &lt; 0.0001), and readmission (11% vs. 8%). The mean additional total hospital cost attributable to POAF was $6705 by paired analysis. A sensitivity analysis of only patients without major complications demonstrated similarly increased resource utilization for patients with POAF. Conclusions: POAF was associated with an increased 9 additional ICU hours, 2 postoperative days, 18% more discharges to a facility, and 33% greater readmissions. An additional $6705 is associated with POAF. These conservative estimates demonstrate the broad impact of POAF on in and out of hospital resource utilization that warrants future efforts at containment and quality improvement.

The impact of post-operative atrial fibrillation on outcomes in coronary artery bypass graft and combined procedures.

BACKGROUNDPost-operative atrial fibrillation (POAF) is a common yet understudied clinical issue after coronary artery bypass graft (CABG) leading to higher mortality rates and stroke. This systematic review and meta-analysis evaluated the rates of adverse outcomes between patients with and without POAF in patients treated with CABG or combined procedures.METHODSThe search period was from the beginning of PubMed and Embase to May 18th, 2020 with no language restrictions. The inclusion criteria were: (1) studies comparing new onset atrial fibrillation before or after revascularization vs. no new onset AF before or after revascularization. The outcomes assessed included all-cause mortality, cardiac death, cerebral vascular accident (CVA), myocardial infarction (MI), repeated revascularization, major adverse cardiac event (MACE), and major adverse cardiac and cerebrovascular events (MACCEs). RESULTSOf the 7,279 entries screened, 11 studies comprising of 57,384 patients were included. Compared to non-POAF, POAF was significantly associated with higher risk of all-cause mortality (Risk Ratio (RR) = 1.58; 95% Confidence Interval (CI): 1.42−1.76, P < 0.00001) with accompanying high level of heterogeneity ( I2 = 62%). ConclusionsPatients with POAF after CABG or combined procedures are at an increased risk of all-cause mortality or CVAs. Therefore, POAF after such procedures should be closely monitored and treated judiciously to minimize risk of further complications. While there are studies on POAF versus no POAF on outcomes, the heterogeneity suggests that further studies are needed.

In-Hospital Postoperative Atrial Fibrillation Indicates a Poorer Clinical Outcome after Myectomy for Obstructive Hypertrophic Cardiomyopathy.

Objectives: This study aims to investigate the risk factors of in-hospital postoperative atrial fibrillation (POAF) and the impact of POAF on the clinical outcome in hypertrophic cardiomyopathy (HCM) patients who underwent myectomy.Methods: Data from a total of 494 obstructive HCM patients, who had undergone preoperative cardiac magnetic resonance (CMR) testing and who underwent myectomy at Fuwai Hospital from June 2011 to June 2016, were collected.Results: Multivariate logistic regression analysis showed that old age (odds ratio [OR], 4.326; 95% confidence interval [CI], 2.248–8.325; p <0.001), maximal left atrium volume (LAV) (OR, 1.137; 95% CI, 1.075–1.202; p <0.001), and hypertension (OR, 2.754; 95% CI, 1.262–6.007; p = 0.011) were associated with the incidence of POAF. In the patients without preoperative AF, Cox regression analysis demonstrated that POAF (p = 0.002), decreased left atrium (LA) ejection fraction (LAEF) (p = 0.036), concomitant procedure (p = 0.039), and postoperative residual moderate or severe mitral valve regurgitation (p = 0.030) were independent predictors of composite cardiovascular events.Conclusions: POAF indicated a poorer clinical outcome after myectomy for obstructive HCM patients, which was similar to those with preoperative AF. Elevated LAV was independently related to POAF onset in HCM patients who underwent myectomy.

Prophylaxis for postoperative atrial fibrillation: A quality initiative study exploring adherence to NICE guidance in a UK tertiary cardiothoracic intensive care unit.

Acute onset atrial fibrillation is a common dysrhythmia experienced by patients following cardiac surgery which can often cause morbidity and extended hospital length of stay. The primary aim of the study was to explore adherence to National Institute for Health and Care Excellence (NICE) guidance which suggests the need for prophylaxis for postoperative atrial fibrillation (POAF). Secondary aims were to explore factors contributing to the development POAF and the impact of POAF on patient-centred outcomes. An analysis consisting of descriptive statistics and regression models was conducted using 138 patient's records who underwent cardiac surgery between January and March 2017. We identified 83 (62%) patients on prophylactic rate control medications prior to surgery. During the study period, a total of 50 patients (36%) developed POAF, of which 28 were on prophylactic medication prior to surgery. Patients who developed POAF had significantly prolonged hospital length of stay compared to those who did not develop POAF. Our study identified a significant proportion of patients not being offered prophylactic rate control prior to cardiac surgery. It is clear that poor patient outcomes are associated with the development of POAF and therefore there is an important need to ensure preventative measures are implemented in guidance relating to the management of these patients. Our results also suggest that tight management of clinical and physiological risk factors prior and during cardiac surgery may improve outcomes in this group of patients and could be considered in future enhanced recovery after cardiac surgery protocols.

Postoperative Atrial Fibrillation and Cardiac Complications After Liver Transplantation

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia, and is associated with significant morbidity and mortality. Postoperative AF has been increasingly identified in non-cardiac surgical patients. Liver transplantation (LT) outcomes have improved in the last two decades, but cardiovascular complications remain the leading cause of death. This is primarily due to the complexity of operations and haemodynamic shifts, which occur intraoperatively. Therefore, LT candidates undergo extensive transplant cardiac workup. The impact of postoperative AF in LT patients is largely unknown.

Impact of atrial fibrillation on long-term survival following oesophagectomy: a 21-year observational study.

Post-operative atrial fibrillation (AF) is a common complication of oesophagectomy and thought to signal a complicated post-operative course. AF is associated with prolonged admissions, increased healthcare costs and inpatient mortality. However, the impact of post-operative AF on long-term outcomes remains uncertain. Patients undergoing open Ivor-Lewis oesophagectomy from 1994 to 2014 at Palmerston North Hospital, New Zealand, were retrospectively evaluated. Demographic, perioperative and tumour variables were collected. Regression models were used to identify independent predictors of AF and assess post-discharge survival following oesophagectomy. In total, 89 patients were included. New-onset AF developed post-operatively in 27 patients (30%). Median follow-up was 6.3 years. Logistic regression identified volume of intravenous fluid in the first 24 h post-operatively as a predictor of AF. Post-discharge survival was predicted by AF occurrence (hazard ratio (HR): 2.99, 95% confidence interval (CI): 1.37-6.53, P = 0.006), preoperative chemoradiotherapy (HR: 0.43, 95% CI: 0.20-0.91, P = 0.03), 1-4 positive lymph nodes (HR: 2.29, 95% CI: 1.06-4.96, P = 0.04), ≥5 positive nodes (HR: 2.95, 95% CI: 1.25-6.94, P = 0.01) and year of operation from 2008 to 2014 (HR: 0.30, 95% CI: 0.12-0.75, P = 0.01). Post-operative AF was associated with poorer long-term survival following oesophagectomy in this cohort. Further research should evaluate the influence of AF on cardiovascular and oncological outcomes following oesophagectomy.

Incidence, Predictors, and Impact of Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting in Military Veterans.

Little is known about the frequency and clinical implications of postoperative atrial fibrillation in military veterans who undergo coronary artery bypass grafting (CABG). We examined long-term survival data, clinical outcomes, and associated risk factors in this population. We retrospectively reviewed baseline, intraoperative, and postoperative data from 1,248 consecutive patients with similar baseline risk profiles who underwent primary isolated CABG at a Veterans Affairs hospital from October 2006 through March 2013. Multivariable logistic regression identified predictors of postoperative atrial fibrillation. Kaplan-Meier analysis was used to evaluate long-term survival (the primary outcome measure), morbidity, and length of hospital stay. Postoperative atrial fibrillation occurred in 215 patients (17.2%). Independent predictors of this sequela were age ≥65 years (odds ratios [95% confidence intervals], 1.7 [1.3-2.4] for patients of age 65-75 yr and 2.6 [1.4-4.8] for patients >75 yr) and body mass index ≥30 kg/m2 (2.0 [1.2-3.2]). Length of stay was longer for patients with postoperative atrial fibrillation than for those without (12.7 ± 6.6 vs 10.3 ± 8.9 d; P ≤0.0001), and the respective 30-day mortality rate was higher (1.9% vs 0.4%; P=0.014). Seven-year survival rates did not differ significantly. Older and obese patients are particularly at risk of postoperative atrial fibrillation after CABG. Patients who develop the sequela have longer hospital stays than, but similar long-term survival rates to, patients who do not.

Postoperative atrial fibrillation: a care study

This care study outlines the pharmacological and non-pharmacological interventions that can be used in the prevention, detection and treatment of postoperative atrial fibrillation (POAF). It examines the impact of POAF, the predisposing risk factors and potential postoperative triggers. The theory behind nursing and medical care given to a patient suffering from POAF is discussed, including the need for preoperative patient education, effective assessment, timely treatment and the interventions needed to limit both the adverse effects of treatment and the complications associated with POAF. It also considers the theory behind rate vs. rhythm control treatment strategy and the use of amiodarone for the effective management of POAF.

Incidence and impact of postoperative atrial fibrillation after minimally invasive esophagectomy.

Atrial fibrillation (AF) following open esophagectomy has been associated with increased rates of pulmonary and anastomotic complications, and mortality. This study seeks to evaluate effects of AF after minimally invasive esophagectomy (MIE). A retrospective review of patients consecutively treated with MIE for esophageal carcinoma, dysplasia. and benign disease from November 2006 to November 2011 was performed. One hundred twenty-one patients underwent MIE. Median age was 65 years (range 26-88) with 85% being male. Thirty-eight (31.4%) patients developed AF postoperatively. Of these 38 patients, 7 (18.4%) had known AF preoperatively. Patients with postoperative AF were significantly older than those without postoperative AF (68.7 vs. 62.8 years, P = 0.008) and more likely to be male (94.7% vs. 80.7%, P = 0.04). Neoadjuvant chemoradiation showed a trend toward increased risk of AF (73.7% vs 56.6%, P = 0.07). Sixty-day mortality was 2 of 38 (5.3%) in patients with AF and 4 of 83 (6.0%) in the no AF cohort (P = 1.00). The group with AF had increased length of hospitalization (13.4 days vs. 10.6 days P = 0.02). No significant differences in rates of pneumonia (31.6% vs. 21.7% P = 0.24), stricture (13.2% vs. 26.5% P = 0.10), or leak requiring return to operating room (13.2% vs. 8.4% P = 0.51) were noted between groups. We did not find an increased rate of AF in our MIE cohort compared with prior reported rates in open esophagectomy populations. AF did result in an increased length of stay but was not a predictor of other short-term morbidities including anastomotic leak, pulmonary complications, stenosis, or 60-day mortality.

A propensity-score matched analysis on the impact of postoperative atrial fibrillation on the early and late outcomes after concomitant aortic valve replacement and coronary artery bypass graft surgery

Postoperative atrial fibrillation (POAF) is a known complication of cardiac surgery. There is a paucity of data on the effects of POAF on short-term and long-term outcomes after concomitant aortic valve replacement and coronary artery bypass grafting (AVR-CABG ). We retrospectively reviewed data on patients without preexisting arrhythmia who underwent isolated first-time AVR-CABG between June 2001 and December 2009 using the Australasian Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database Program. Preoperative characteristics, early postoperative outcomes and late survival were compared between patients who developed POAF and those who did not. Propensity score matching was performed to account for the differences between the two groups. Isolated AVR-CABG surgery was performed in 2028 patients without preexisting arrhythmias at 18 Australian institutions, of whom 894 (44.1%) developed POAF. POAF patients were generally older (mean age, 75 vs. 73 years, P < 0.001). From the initial study population, 715 propensity-matched patient-pairs were derived; the overall matching rate was 80.0%. In the matched groups, 30-day mortality was similar in both groups (3.5 vs. 2.1%, P = 0.16). Patients with POAF, however, were more likely to develop perioperative complications, including new renal failure, prolonged ventilation (>24 h), multisystem failure and readmission within 30 days of surgery (all P < 0.05). Patients with POAF also had a significantly greater length of hospital stay (P < 0.001). Seven-year survival was not significantly different between the two groups (72 vs. 75%, P = 0.11). POAF was not associated with an increased risk of early or late mortality. It is, however, associated with poorer perioperative outcomes. It is important to evaluate potential treatment strategies for POAF.

The Impact of Postoperative Atrial Fibrillation and Race on Long-Term Survival after Coronary Artery Bypass Grafting

Postoperative atrial fibrillation (POAF) is a known predictor of in-hospital morbidity and short-term survival after coronary artery bypass grafting (CABG). The impact of race and long-term survival has not been examined in this population. We aimed to examine the influence of these factors on long-term survival in patients undergoing CABG.Patients undergoing first-time, isolated CABG between 1992 and 2011 were included in this study. Long-term survival was compared in patients with and without POAF and stratified by race. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model.A total of 2,907 (22%) patients developed POAF (black n=370; white n=2,537) following CABG (N=13,165). Median follow-up for study participants was 8.2 years. Long-term survival after CABG differed by POAF status and race (no POAF: HR=1.0; white POAF: adjusted HR=1.1, 95% CI=1.06-1.2; black POAF: adjusted HR=1.4, 95% CI=1.2-1.6; pTrend=0.0002). lack POAF patients also died sooner after surgery than their white counterparts (adjusted HR=1.2, 95% CI=1.02-1.4).Black race was a statistically significant predictor of decreased survival among POAF patients after CABG. This finding provides useful outcome information for surgeons and their patients.

Impact of postoperative atrial fibrillation on long- term morbidity and mortality after cardiac surgery

Impact of postoperative atrial fibrillation on long- term morbidity and mortality after cardiac surgery

Post-operative Atrial Fibrillation - Pathophysiology, Treatment and Prevention.

Atrial fibrillation occurring after cardiac surgery has been the subject of intensive research over the past decades. However, the incidence remains high, despite numerous preventive and treatment strategies. In addition, several reports show that the impact of post-operative atrial fibrillation (POAF) is high. It is an independent risk factor for mortality after several years. These findings make clear that the pathophysiology of POAF is not fully understood and POAF-associated risks to some extent might be underestimated. On the one hand, excessive triggers during the acute post operative phase after cardiac surgery might initiate AF even in atria with low vulnerability. On the other hand, many patients undergoing surgery have an atrial substrate at the time of operation promoting AF not only in the post-operative phase but also in the days and weeks thereafter. Progress in our understanding of the AF mechanisms in general has provided valuable insights into processes involved in atrial structural remodeling due to advanced age, hypertension, obesity, and congestive heart failure. These patient characteristics strongly contribute to cardiac disease, predict POAF and likely have an impact on the risk of thrombus formation in the weeks and months after cardiac surgery. For a better understanding of the mechanisms involved, it is important to not only recognize the occurrence of POAF by continuous monitoring after surgery, but also to identity the extent of atrial vulnerability to AF in these patients.

Management Strategies in Cardiac Surgery for Postoperative Atrial Fibrillation: Contemporary Prophylaxis and Futuristic Anticoagulant Possibilities

With more than a third of patients expected to endure the arrhythmia at any given time point, atrial fibrillation after cardiac surgery becomes a vexing problem in the postoperative care of cardiac surgery patients. The impact on patient care covers a spectrum from the more common clinically insignificant sequelae to debilitating embolic events. Despite this, postoperative atrial fibrillation generally masquerades as being insignificant, or at most as an anticipated inherent risk, merely extending one's hospital stay by a few days. As an independent risk factor for stroke, early and late mortality, and being a multibillion dollar strain on the healthcare system annually, postoperative atrial fibrillation is far more flagrant than a mere inherent risk. It is a serious medical quandary, which is not recognized as such. Though complete prevention is unrealistic, a step-wise treatment strategy that incorporates multiple preventative modalities can significantly reduce the impact of postoperative atrial fibrillation on patient care. The aims of this review are to present a brief overview of the arrhythmia's etiology, risk factors, and preventative strategies to reduce associated morbidities. Newer anticoagulants and the potential role of these drugs on future treatment paradigms are also discussed.