Postoperative Atrial Fibrillation Understanding Causes and Risks

Pereira, Marcel de Paula

doi:10.33552/ojcr.2019.03.000560

Cited by 1 publication

(1 citation statement)

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“…Postoperative atrial fibrillation (POAF) occurs in up to 40–50% of patients undergoing cardiac surgery, and has been associated with stroke, longer hospital stays and an increased risk of 30-day mortality [1,2 ▪ ,3]. Recent studies with longer term rhythm monitoring devices have pointed to a previously underappreciated risk of protracted atrial fibrillation [4 ▪ ].…”

Section: Introductionmentioning

confidence: 99%

Routine left atrial appendage occlusion in patients undergoing cardiac surgery: a narrative review

Fatima

Dhingra

Ribeiro

et al. 2021

Current Opinion in Cardiology

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Purpose of reviewNew evidence suggests a greater prevalence of protracted postoperative atrial fibrillation (POAF) than previously recognized. The left atrial appendage (LAA) is the most common source of embolism in patients with nonvalvular atrial fibrillation. In this review, we ask whether there is evidence to support routine LAA occlusion (LAAO) in patients without preexisting atrial fibrillation undergoing cardiac surgery. Recent findingsOverall, available studies are small, inconsistent and have varying proportions of patients with and without preexisting atrial fibrillation. There is considerable discrepancy with respect to the efficacy of LAAO in reducing the risk of POAF-related stroke. Only one study reported a lower rate of stroke in the LAAO group compared with no LAAO. Two studies included a subgroup analysis of patients that developed POAF and report a significantly higher rate of stroke in patients that developed POAF and did not undergo LAAO. There are three clinical trials ongoing that are investigating prophylactic LAAO in patients undergoing cardiac surgery: ATLAS, LAA-CLOSURE and LAACS-2. SummaryThere is currently insufficient evidence to recommend routine addition of LAAO to lower the risk of postoperative stroke. Ongoing clinical trials will provide important insight into the role of routine LAAO in all patients undergoing cardiac surgery.

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Section: Introductionmentioning

confidence: 99%