The Year in Cardiovascularmedicine 2020: Arrhythmias

Harry J.G.M. Crijns; Frits Prinzen; Pier D. Lambiase; Prashanthan Sanders; Josep Brugada


Eur Heart J. 2021;42(5):499-507. 

In This Article

Postoperative Atrial Fibrillation

The risk of stroke and other adverse outcomes after postoperative AF (POAF) was reported from the combined datasets of the randomized POISE trials on the effects of metoprolol vs. placebo, aspirin vs. placebo, and clonidine vs. placebo.[39] Patients with cardiovascular disease were undergoing non-cardiac surgery. POAF within 30 days after surgery was seen in 404 of 18 117 patients and was associated with 1-year stroke incidence of 5.6% compared to 1.5% in no-POAF patients. Also, risk of death (31.3% vs. 9.3%) and myocardial infarction (26.2 vs. 8.2) were increased (Figure 2). Risk reduction strategies still need to be investigated. This knowledge gap was unfortunately not filled by a recent randomized trial testing the sedative dexmedetomidine against placebo to reduce new-onset POAF as well as delirium in 798 patients undergoing cardiac surgery.[40] The incidence of new POAF (~32%) and delirium (~15%) did not differ between study groups.

Figure 2.

Adverse events per 100 patient-years follow-up in patients with cardiovascular disease after non-cardiac surgery indicate that postoperative atrial fibrillation is associated with a significantly elevated incidence of cardiovascular adverse events. Reprinted with permission from Ref.39