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Postoperative atrial fibrillation after non-cardiac surgery: How important is it and what do we do about it?

  • Michael Ke Wang
    Correspondence
    Corresponding author.
    Affiliations
    Department of Medicine, McMaster University, Hamilton, Canada

    Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada

    Population Health Research Institute, McMaster University, Hamilton, Canada
    Search for articles by this author
  • James Douketis
    Affiliations
    Department of Medicine, McMaster University, Hamilton, Canada

    Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
    Search for articles by this author
Published:February 03, 2021DOI:https://doi.org/10.1016/j.ejim.2021.01.024
      Postoperative atrial fibrillation (POAF), defined as the occurrence of new-onset AF in the perioperative setting, is a common complication occurring in up to 3% of patients undergoing non-cardiothoracic procedures and in 30-50% of patients undergoing cardiothoracic procedures.[
      • Bessissow A.
      • Khan J.
      • Devereaux P.J.
      • Alvarez-Garcia J.
      Alonso-Coello P. Postoperative atrial fibrillation in non-cardiac and cardiac surgery: an overview.
      ] While a subset of patients with POAF will subsequently develop cardiorespiratory symptoms or hemodynamic instability,[
      • Bhave P.D.
      • Goldman L.E.
      • Vittinghoff E.
      • Maselli J.
      • Auerbach A
      Incidence, predictors, and outcomes associated with postoperative atrial fibrillation after major noncardiac surgery.
      ] most episodes of POAF are brief, self-limited, and asymptomatic. There are two key questions relating to POAF that remain unanswered: (i) to what extent is POAF associated with long-term clinical consequences, primarily stroke; and (ii) does anticoagulation provide therapeutic benefit to mitigate such risk?
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