Postoperative atrial fibrillation: Target for stroke prevention?

Abstract

Purpose: A substantial number of patients without a history of atrial fibrillation who undergo surgery develop one or more episodes of atrial fibrillation in the first few days after the operation. We studied whether postoperative transient atrial fibrillation is a risk factor for future atrial fibrillation, stroke and death. Method: We performed a narrative review of the literature on epidemiology, mechanisms, risk of atrial fibrillation, stroke and death after postoperative atrial fibrillation. We reviewed antithrombotic guidelines on this topic and identified gaps in current management. Findings: Patients with postoperative atrial fibrillation are at high risk of developing atrial fibrillation in the long term. Mortality is also increased. Most, but not all observational studies report a higher risk of stroke. The optimal antithrombotic regimen for patients with postoperative atrial fibrillation has not been defined. The role of lifestyle changes and of surgical occlusion of the left atrial appendage in preventing adverse outcomes after postoperative atrial fibrillation is not established. Conclusion: Further studies are warranted to establish the optimal strategy to prevent adverse long-term outcomes after transient, postoperative atrial fibrillation. KeywordsAtrial fibrillation, stroke, prevention, cardiac surgery, coronary artery disease A substantial number of patients without a history of atrial fibrillation (AF) who undergo surgery develop one or more episodes of AF in the first few days after the operation. This condition is termed postoperative AF or postoperative atrial fibrillation (POAF). Up to 90% of these episodes resolve spontaneously. A widely held belief is that POAF is benign and has no long-term consequences.1-3 However, recent studies indicate that transient POAF is a risk factor for development of future AF, stroke and death up to several years after the procedure. These are the focus of this review.Whether the increased stroke and mortality rates are directly related to thromboembolism due to recurrent AF or a higher baseline cardiovascular risk is not established.Furthermore it is unclear if anticoagulation should be recommended in these patients. The 2016 ESC Guidelines on AF do not provide specific recommendations on type and duration of anticoagulation

Autonomic Nervous System and Stress to Predict Secondary Ischemic Events after Transient Ischemic Attack or Minor Stroke: Possible Implications of Heart Rate Variability

“…Moreover, cardiac surgical procedures often cause AF. As described in the last section, this is associated with an increased risk of embolic strokes, and the use of beta-blockers aims at preventing such strokes ( 120 , 121 ).…”

Atrial Fibrillation for the Neurologist: Preventing both Ischemic and Hemorrhagic Strokes

“…Atrial fibrillation is also common around the time of valvular, other cardiac or non-cardiac surgical procedures [ 64 , 65 ]. Post-operative AF has been shown to be associated with the risk of stroke in most studies [ 66 ]. The decision to anticogulate in this setting and its duration should be decided in conjunction with the surgeon and cardiologist who were involved with the surgical procedure.…”

Self-monitoring for recurrence of secondary atrial fibrillation following non-cardiac surgery or acute illness: A pilot study

“…Secondary AF is often considered to be transient and provoked, because mostly it resolves spontaneously without need for cardioversion, and subsequently there is uncertainty about the need for treatment [8] , [9] , [10] . However, retrospective registry data show patients with transient AF experience a recurrent AF episode in 42–44% of medical patients within 5 years [1] , [3] , [11] and a recurrence rate of 15% following non-cardiac surgery over ~2.5 years [12] .…”