Post-operative Atrial Fibrillation: Should We Anticoagulate?

Overview

Journal Ann Transl Med

Publisher AME Publishing Company

Date 2019 Oct 30

PMID 31660306

Citations 10

Authors

Pooja S Jagadish

Irene Kirolos

Sarthak Khare

Aranyak Rawal

Victor Lin

Rami N Khouzam

Affiliations

Soon will be listed here.

Abstract

The prevalence of atrial fibrillation (AF) is estimated to be 12 million by the year 2030. A subset of those patients fall into the category of post-operative atrial fibrillation (POAF) and either develop POAF after cardiac procedures [coronary artery bypass graft (CABG) and valvular procedures] or non-cardiac procedures. With the rise in surgical procedures, POAF represents a significant economic burden. POAF usually converts to sinus rhythm on its own, prompting questions about whether there is a need to treat it and if there is a need for anticoagulation. This review discusses risk factors, pathophysiology, complications of POAF, and mechanisms of risk stratifying patients to determine when to anticoagulate.

Citing Articles

Cardiac myxoma discovery behind chronic carotid occlusion in stroke.

Hamissou I, Wintzer-Wehekind J Glob Cardiol Sci Pract. 2025; 2024(6):e202449.

PMID: 40026587 PMC: 11871564. DOI: 10.21542/gcsp.2024.49.

2024 Literature Review of Postoperative Atrial Fibrillation: A Surgeon's Perspective.

Kiser A J Innov Card Rhythm Manag. 2025; 16(1):6154-6157.

PMID: 39897722 PMC: 11784400. DOI: 10.19102/icrm.2025.16017.

The effect of spironolactone in reducing the risk of postoperative atrial fibrillation in patients undergoing coronary artery bypass graft surgery: randomized single-blind placebo-controlled study.

Farzaneh A, Moradi M, Safarpoor G, Karamian A Gen Thorac Cardiovasc Surg. 2024; .

PMID: 39485613 DOI: 10.1007/s11748-024-02101-2.

Risk Factors of Postoperative Atrial Fibrillation After Isolated Coronary Artery Bypass Grafting Surgery in the Recent 10 Years: Clinical Analysis of 6229 Patients.

Zhou J, Zhang J, Xi L, Guo Z, Liu X, Liu Z Clin Cardiol. 2024; 47(10):e24335.

PMID: 39431537 PMC: 11492150. DOI: 10.1002/clc.24335.

Postoperative Atrial Fibrillation: A Review.

Shah S, Chahil V, Battisha A, Haq S, Kalra D Biomedicines. 2024; 12(9).

PMID: 39335482 PMC: 11428825. DOI: 10.3390/biomedicines12091968.

References

Ayoub K, Habash F, Almomani A, Xu J, Marji M, Shaw-Devine A . Long Term Risk of Recurrent Atrial Fibrillation and Ischemic Stroke after Post-Operative Atrial Fibrillation Complicating Cardiac and Non-Cardiac Surgeries. J Atr Fibrillation. 2018; 10(6):1660. PMC: 6009790. DOI: 10.4022/jafib.1660. View

Passman R, Gingold D, Amar D, Lloyd-Jones D, Bennett C, Zhang H . Prediction rule for atrial fibrillation after major noncardiac thoracic surgery. Ann Thorac Surg. 2005; 79(5):1698-703. DOI: 10.1016/j.athoracsur.2004.10.058. View

Quon M, Behlouli H, Pilote L . Anticoagulant Use and Risk of Ischemic Stroke and Bleeding in Patients With Secondary Atrial Fibrillation Associated With Acute Coronary Syndromes, Acute Pulmonary Disease, or Sepsis. JACC Clin Electrophysiol. 2018; 4(3):386-393. DOI: 10.1016/j.jacep.2017.08.003. View

Smith H, Yeung C, Gowing S, Sadek M, Maziak D, Gilbert S . A review and analysis of strategies for prediction, prevention and management of post-operative atrial fibrillation after non-cardiac thoracic surgery. J Thorac Dis. 2018; 10(Suppl 32):S3799-S3808. PMC: 6258651. DOI: 10.21037/jtd.2018.09.144. View

Helgadottir S, Sigurdsson M, Ingvarsdottir I, Arnar D, Gudbjartsson T . Atrial fibrillation following cardiac surgery: risk analysis and long-term survival. J Cardiothorac Surg. 2012; 7:87. PMC: 3515503. DOI: 10.1186/1749-8090-7-87. View

Lubitz S, Yin X, Rienstra M, Schnabel R, Walkey A, Magnani J . Long-term outcomes of secondary atrial fibrillation in the community: the Framingham Heart Study. Circulation. 2015; 131(19):1648-55. PMC: 4430386. DOI: 10.1161/CIRCULATIONAHA.114.014058. View

Lin M, Kamel H, Singer D, Wu Y, Lee M, Ovbiagele B . Perioperative/Postoperative Atrial Fibrillation and Risk of Subsequent Stroke and/or Mortality. Stroke. 2019; 50(6):1364-1371. DOI: 10.1161/STROKEAHA.118.023921. View

El-Chami M, Merchant F, Smith P, Levy M, Nelms A, Merlino J . Management of New-Onset Postoperative Atrial Fibrillation Utilizing Insertable Cardiac Monitor Technology to Observe Recurrence of AF (MONITOR-AF). Pacing Clin Electrophysiol. 2016; 39(10):1083-1089. DOI: 10.1111/pace.12949. View

Benjamin E, Muntner P, Alonso A, Bittencourt M, Callaway C, Carson A . Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation. 2019; 139(10):e56-e528. DOI: 10.1161/CIR.0000000000000659. View

10.

Vaporciyan A, Correa A, Rice D, Roth J, Smythe W, Swisher S . Risk factors associated with atrial fibrillation after noncardiac thoracic surgery: analysis of 2588 patients. J Thorac Cardiovasc Surg. 2004; 127(3):779-86. DOI: 10.1016/j.jtcvs.2003.07.011. View

11.

Butt J, Olesen J, Havers-Borgersen E, Gundlund A, Andersson C, Gislason G . Risk of Thromboembolism Associated With Atrial Fibrillation Following Noncardiac Surgery. J Am Coll Cardiol. 2018; 72(17):2027-2036. DOI: 10.1016/j.jacc.2018.07.088. View

12.

Kolvekar S, Dsouza A, Akhtar P, Reek C, Garratt C, Spyt T . Role of atrial ischaemia in development of atrial fibrillation following coronary artery bypass surgery. Eur J Cardiothorac Surg. 1997; 11(1):70-5. DOI: 10.1016/s1010-7940(96)01095-0. View

13.

Bhave P, Elizabeth Goldman L, Vittinghoff E, Maselli J, Auerbach A . Incidence, predictors, and outcomes associated with postoperative atrial fibrillation after major noncardiac surgery. Am Heart J. 2012; 164(6):918-24. PMC: 4096141. DOI: 10.1016/j.ahj.2012.09.004. View

14.

January C, Samuel Wann L, Calkins H, Chen L, Cigarroa J, Cleveland Jr J . 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the.... Heart Rhythm. 2019; 16(8):e66-e93. DOI: 10.1016/j.hrthm.2019.01.024. View

15.

Walsh S, Tang T, Gaunt M, Schneider H . New arrhythmias after non-cardiothoracic surgery. BMJ. 2006; 333(7571):715. PMC: 1592375. DOI: 10.1136/bmj.333.7571.715. View

16.

January C, Samuel Wann L, Alpert J, Calkins H, Cigarroa J, Cleveland Jr J . 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014; 130(23):e199-267. PMC: 4676081. DOI: 10.1161/CIR.0000000000000041. View

17.

Lowres N, Mulcahy G, Jin K, Gallagher R, Neubeck L, Freedman B . Incidence of postoperative atrial fibrillation recurrence in patients discharged in sinus rhythm after cardiac surgery: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg. 2017; 26(3):504-511. DOI: 10.1093/icvts/ivx348. View

18.

Bessissow A, Khan J, Devereaux P, Alvarez-Garcia J, Alonso-Coello P . Postoperative atrial fibrillation in non-cardiac and cardiac surgery: an overview. J Thromb Haemost. 2015; 13 Suppl 1:S304-12. DOI: 10.1111/jth.12974. View

19.

Mariscalco G, Biancari F, Zanobini M, Cottini M, Piffaretti G, Saccocci M . Bedside tool for predicting the risk of postoperative atrial fibrillation after cardiac surgery: the POAF score. J Am Heart Assoc. 2014; 3(2):e000752. PMC: 4187480. DOI: 10.1161/JAHA.113.000752. View

20.

Higuchi S, Kabeya Y, Matsushita K, Tachibana K, Kawachi R, Takei H . The study protocol for PREDICT AF RECURRENCE: a PRospEctive cohort stuDy of surveIllanCe for perioperaTive Atrial Fibrillation RECURRENCE in major non-cardiac surgery for malignancy. BMC Cardiovasc Disord. 2018; 18(1):127. PMC: 6019832. DOI: 10.1186/s12872-018-0862-9. View