Postoperative Atrial Fibrillation

Abstract

Postoperative atrial fibrillation (POAF) is common among surgical patients and associated with a worse outcome. Pathophysiology of POAF is not fully disclosed, and several perioperative factors could be involved. Direct cardiac stimulation from perioperative use of catecholamines or increased sympathetic outflow from volume loss/anaemia/pain may play a role. Metabolic alterations, such as hypo-/hyperglycaemia and electrolyte disturbances, may also contribute to POAF. Moreover, inflammation, both systemic and local, may play a role in its pathogenesis. Strategies to prevent POAF aim at reducing its incidence and ameliorate global outcome of surgical patients. Nonpharmacological prophylaxis includes an adequate control of postoperative pain, the use of thoracic epidural analgesia, optimization of perioperative oxygen delivery, and, possibly, modulation of surgery-associated inflammatory response with immunonutrition and antioxidants. Perioperative potassium and magnesium depletion should be corrected. The impact of those interventions on patients outcome needs to be further investigated.

Prevention of Atrial Fibrillation in High-risk Patients Undergoing Lung Cancer Surgery

“…7,[40][41][42][43] Fewer data exist regarding mechanisms of PAF after pulmonary resection; it may be associated with various surgical stresses, such as excitation of sympathetic nerve activity, right ventricular overload, hypoxia, and systemic inflammatory responses. 2,44 The NT-proBNP level increases have been found in several clinical conditions, such as left ventricular hypertrophy, hypertension, left atrial enlargement, and heart failure. 45 In 2004, Wazni et al reported that increased BNP levels may predict PAF in patients undergoing cardiac surgery.…”

Decreased Bioenergetic Health Index in monocytes isolated from the pericardial fluid and blood of post-operative cardiac surgery patients

“…Other studies have shown that this pro-inflammatory state may also be reflected to a lesser extent in the systemic circulation. Some inflammatory markers in the serum of post-operative cardiac surgery patients have appeared elevated and correlated with increased occurrences of cardiac dysfunction and atrial fibrillation [6][7][8]. We have recently proposed that the focus for the initiation of the pro-inflammatory response after surgery is the post-operative pericardial fluid (PO-PCF) and that the oxidative stress in this compartment is more severe than in the blood [5].…”

Pathophysiology of cancer therapy-provoked atrial fibrillation

“…It was connected with increased intensive care utilization and hospital length of stay, morbidity, mortality, hospital readmissions, and longterm risk of stroke [17]. Besides, the prevalence of POAF was 16%-46% following cardiothoracic surgery and was 0.4%-12% following noncardiothoracic surgery [19]. In lung cancer, AF is most frequently seen during thoracic surgery, especially pulmonary resection [20].…”