New-onset atrial fibrillation after cardiac surgery: Clinical impact, prevention and treatment

Postoperative, new-onset atrial fibrillation is one of the most common complications after cardiac surgical procedures (30–50%) and is associated with a significant increase in morbidity, mortality and longer length of in-hospital stay. The main preoperative risk factors include higher age, mitral valve disease and left atrial dilation. The pathomechanism is multifactorial and includes both a predisposition and the presence of perioperative “triggers”. The recommended preventative drugs include oral β‑blockers and amiodarone. To prevent postoperative thromboembolic events balanced parenteral anticoagulation should be started, keeping the individual risk of bleeding in mind. New-onset atrial fibrillation which remains for more than 48 h should be treated with long-term oral anticoagulation. The rhythm- and frequency-control strategies are determined by hemodynamic stability, clinical symptoms and patient preference. © 2017, Springer-Verlag Berlin Heidelberg.