Is It Time to Treat Post-operative Atrial Fibrillation Just Like Regular Atrial Fibrillation?

Dipak Kotecha; Manuel Castellá


Eur Heart J. 2020;41(5):652-654a. 

In This Article

Abstract and Introduction


The next era of cardiovascular medicine in developed countries will be dominated by the need to address the healthcare and patient burdens of ageing-associated conditions such as atrial fibrillation (AF).[1] The impact of AF extends widely, including a contribution to poor outcomes for patients after surgical procedures and unsustainable healthcare costs. The conventional thought is that post-operative AF is just a transient and self-limiting condition resulting from the surgical milieu (pro-inflammatory, intracellular electrolyte disturbance and surgery-specific factors). However, there is increasing evidence that AF frequently recurs and is associated with long-term adverse outcomes. In the context of cardiac surgery, we know that post-operative AF is not just an inconvenience; for example, in 16 169 consecutive patients who underwent isolated bypass surgery at a single US centre, survival rates at 10 years after surgery were 55% in those with post-operative AF requiring treatment, compared with 70% without post-operative AF.[2] AF is frequently diagnosed after cardiac surgery, with 33% of patients developing post-operative AF in the Rate Control Versus Rhythm Control For Postoperative Atrial Fibrillation trial, increasing to ~50% in those who also required valve surgery.[3] However, post-operative AF is not just confined to cardiac surgery, occurring in 11% of patients undergoing general abdominal surgery across 13 studies.[4] The implications of post-operative AF in the non-cardiac surgery setting are unclear. In this issue of the European Heart Journal, Conen et al. seek to address this knowledge gap and provide confirmation that AF, regardless of aetiology, is associated with a high risk of stroke and death that requires effective management.[5]