Postoperative atrial fibrillation

Amerena, 2013Arsenault, 2013January, 2014January, 2019

Atrial fibrillation is a common postoperative complication, particularly after cardiac surgery. Many cases of postoperative atrial fibrillation spontaneously revert within 24 hours. Beta blockers and amiodarone have been shown to reduce postoperative atrial fibrillation; seek specialist cardiologist advice about whether to use these drugs preventivelyHindricks, 2021. Treat predisposing and contributing factors such as hypoxia, sepsis and electrolyte abnormalities.

In patients with postoperative atrial fibrillation causing haemodynamic instability, electrical or pharmacological cardioversion should be considered.

In patients with postoperative atrial fibrillation who are haemodynamically stable, there does not appear to be any difference in medium-term outcomes between rate or rhythm control. If spontaneous reversion does not occur within 24 hours, and the patient is asymptomatic, consider a rate control strategy; if the patient has symptoms, consider a rhythm control strategyHindricks, 2021.

If postoperative atrial fibrillation is persistent, treat it as per any other case of new-onset atrial fibrillationGillinov, 2016National Institute for Health and Care Excellence (NICE), 2021.

The need for anticoagulant therapy for patients with postoperative atrial fibrillation depends on the balance of postoperative bleeding risk versus thromboembolic event risk (see Overview of prevention of thromboembolic events in patients with atrial fibrillation).