Atrial fibrillation (AF) - NYSORA

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Atrial fibrillation (AF)

Learning objectives

  • Describe the overall mechanisms of AF
  • Recognize risk factors for perioperative AF
  • Manage patients with AF or risk of AF

Definition & mechanisms

  • Atrial fibrillation (AF) is the most common sustained arrhythmia
  • Very rapid and uncoordinated atrial activity
  • Twofold increase in premature mortality
  • Important factor in major adverse cardiovascular events such as heart failure, severe stroke, and myocardial infarction
  • Initiation and maintenance of AF can be linked to “trigger” (initiating event) and “substrate” (atrial remodeling that maintains AF)
  • Risk of congestive heart failure, embolic events, stroke

Risk factors for perioperative AF

AgeHypovolemia and hypervolemia
Race (lower risk in African population)Hypoxia
History of atrial fibrillationIntraoperative hypotension
Congestive heart failureCatecholamine versus noncatecholamine vasopressor use
Ischemic heart diseaseTrauma
Chronic renal failure Type of surgery
AsthmaElectrolyte abnormalities (primarily hypokalemia and
Cardiac valvular disease
Obstructive sleep apnea


atrial fibrillation, management, anticoagulation, atrioventricular nodal blocking agents, rapid ventricular rate RVR, hypotension, hypoxia, hypercarbia, cardioversion, beta-blockers, calcium channel, amiodarone, digoxin, transesophageal echocardiography, arrhythmogenic, ketamine, adrenergic vasopressors, desflurane, glycopyrrolate, atropine, obstuctive sleep apnea, point of care ultrasound, rate control, antithrombotic

Keep in mind

  • Patients who develop perioperative AF have higher in-hospital mortality and longer hospital lengths of stay
  • Those with preexisting AF who develop perioperative AF have similar outcomes compared with patients who develop perioperative AF de novo

Suggested reading

  • Karamchandani K, Khanna AK, Bose S, Fernando RJ, Walkey AJ. Atrial Fibrillation: Current Evidence and Management Strategies During the Perioperative Period. Anesthesia & Analgesia. 2020;130(1).
  • Wijesurendra RS, Casadei B. Mechanisms of atrial fibrillation. Heart. 2019;105(24):1860-1867

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