Managing atrial fibrillation after cardiac surgery

Abstract

Open-heart surgery involves the opening of the thoracic cage followed by surgical intervention on the cardiac muscle, arteries, valves, or other structures. It is indicated for many cardiac diseases such as coronary artery blockage, valvular heart stenosis or calcification, aortic aneurysm or dissection ( National Heart, Lung, and Blood Institute, 2013 ). As with any surgery, it contains several complications, one of which is dysrhythmia, and atrial fibrillation (AF) is the most predominant of these ( Peretto et al, 2014 ). AF involves an abnormal elevated heart rate and irregular rhythm, resulting from abnormal electrical discharge from the atrium rather than the sinoatrial node (SA). AF post operation is common in surgeries of the heart and chest, as well as other non-cardiothoracic surgeries ( Mostafa et al, 2012 ). According to the American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS), AF can be classified based on duration into: paroxysmal AF, which resolves by intervention or spontaneously within 7 days of onset; persistent AF, which continues for more than 7 days; longstanding AF, which continues for more than 12 months; permanent AF, which cannot be restored to sinus rhythm; and non-valvular AF, in which the occurrence of AF is unrelated to rheumatic mitral valve disease, a prosthetic heart valve, or mitral valve repair ( January et al, 2014 ).

Rate vs rhythm: beta blockers and antiarrhythmics as pharmacological options for the treatment of postoperative atrial fibrillation

“…Although often a transient condition that does occasionally resolve spontaneously, POAF has been described as a malignant condition which can directly affect patient outcomes post cardiac surgery (Attaran et al 2012, Raiten et al 2015and Gillinov et al 2016. In essence, the development of POAF is due to ectopic firing or a re-entry mechanism which may have been initiated by the inflammatory response caused by the surgery or by the presence of an atrial substrate (Younis 2017& Norhayati et al 2020.…”