Vincent Thijs1,2, Robin Lemmens3,4,5, Omar Farouque6,7, Geoffrey Donnan1, Hein Heidbuchel8,9. 1. Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia. 2. Department of Neurology, Austin Health, Heidelberg, Victoria, Australia. 3. KU Leuven, University of Leuven, Department of Neurosciences, Experimental Neurology and Leuven Institute for Neuroscience and Disease (LIND), Leuven, Belgium. 4. VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium. 5. University Hospitals Leuven, Department of Neurology, Leuven, Belgium. 6. Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia. 7. Department of Medicine, University of Melbourne, Victoria, Australia. 8. Department of Cardiology, University Hospitals Antwerp, Antwerp, Belgium. 9. Department of Cardiology, Antwerp University, Antwerp, Belgium.
Abstract
PURPOSE: A substantial number of patients without a history of atrial fibrillation who undergo surgery develop one or more episodes of atrial fibrillation in the first few days after the operation. We studied whether postoperative transient atrial fibrillation is a risk factor for future atrial fibrillation, stroke and death. METHOD: We performed a narrative review of the literature on epidemiology, mechanisms, risk of atrial fibrillation, stroke and death after postoperative atrial fibrillation. We reviewed antithrombotic guidelines on this topic and identified gaps in current management. FINDINGS: Patients with postoperative atrial fibrillation are at high risk of developing atrial fibrillation in the long term. Mortality is also increased. Most, but not all observational studies report a higher risk of stroke. The optimal antithrombotic regimen for patients with postoperative atrial fibrillation has not been defined. The role of lifestyle changes and of surgical occlusion of the left atrial appendage in preventing adverse outcomes after postoperative atrial fibrillation is not established. CONCLUSION: Further studies are warranted to establish the optimal strategy to prevent adverse long-term outcomes after transient, postoperative atrial fibrillation.
PURPOSE: A substantial number of patients without a history of atrial fibrillation who undergo surgery develop one or more episodes of atrial fibrillation in the first few days after the operation. We studied whether postoperative transient atrial fibrillation is a risk factor for future atrial fibrillation, stroke and death. METHOD: We performed a narrative review of the literature on epidemiology, mechanisms, risk of atrial fibrillation, stroke and death after postoperative atrial fibrillation. We reviewed antithrombotic guidelines on this topic and identified gaps in current management. FINDINGS: Patients with postoperative atrial fibrillation are at high risk of developing atrial fibrillation in the long term. Mortality is also increased. Most, but not all observational studies report a higher risk of stroke. The optimal antithrombotic regimen for patients with postoperative atrial fibrillation has not been defined. The role of lifestyle changes and of surgical occlusion of the left atrial appendage in preventing adverse outcomes after postoperative atrial fibrillation is not established. CONCLUSION: Further studies are warranted to establish the optimal strategy to prevent adverse long-term outcomes after transient, postoperative atrial fibrillation.
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