Atrial Fibrillation: Current Evidence and Management Strategies During the Perioperative Period

Anesth Analg. 2020 Jan;130(1):2-13. doi: 10.1213/ANE.0000000000004474.

Abstract

Atrial fibrillation (AF) is the most common arrhythmia in the perioperative period. Previously considered a benign and self-limited entity, recent data suggest that perioperative AF is associated with considerable morbidity and mortality and may predict long-term AF and stroke risk in some patients. Despite known risk factors, AF remains largely unpredictable, especially after noncardiac surgery. As a consequence, strategies to minimize perioperative risk are mostly supportive and include avoiding potential arrhythmogenic triggers and proactively treating patient- and surgery-related factors that might precipitate AF. In addition to managing AF itself, clinicians must also address the hemodynamic perturbations that result from AF to prevent end-organ dysfunction. This review will discuss current evidence with respect to causes, risk factors, and outcomes of patients with AF, and address current controversies in the perioperative setting.

Publication types

  • Review

MeSH terms

  • Atrial Fibrillation / etiology
  • Atrial Fibrillation / mortality
  • Atrial Fibrillation / physiopathology
  • Atrial Fibrillation / therapy*
  • Hemodynamics
  • Humans
  • Perioperative Period
  • Prognosis
  • Risk Assessment
  • Risk Factors
  • Surgical Procedures, Operative / adverse effects*
  • Surgical Procedures, Operative / mortality