Atrial fibrillation in cardiac surgery

Atrial fibrillation (AF) is the most frequent arrhythmia in the post-operative period of cardiac surgery. It is associated with heart failure, renal insufficiency, systemic embolism, and increase in days of in-hospital and mortality. AF in the post-operative period of cardiac surgery (FAPCC) usually appears in the first 48 h after surgery. The main mechanisms involved in the appearance and maintenance of FAPCC are the increase in sympathetic tone and the inflammatory response. The associated risk factors are advanced age, chronic obstructive pulmonary disease, chronic kidney disease, valve surgery, fraction of ejection of the left ventricle < 40%, and the withdrawal of beta-blocker (BB) drugs. There are instruments that have been shown to predict the appearance of FAPCC. Prophylactic treatment with BBs and amiodarone is associated with a decrease in the appearance of FAPCC. Given its transient nature, it is suggested that the initial treatment of FAPCC be the heart rate control and only if the treatment does not achieve a return to sinus rhythm, the use of electrical cardioversion is suggested. It is unknown what should be the long-term follow-up and complications beyond this period are little known. FAPCC is not a benign or isolated arrhythmia in patients undergoing cardiac surgery, so the identification of risk factors, their prevention, and follow-up in the outpatient setting, should be part of the units dedicated to the care and care of these patients.