Postoperative atrial fibrillation (PoAF), a common complication of cardiac surgery, contributes significantly to morbidity, mortality, and increasing healthcare costs. Despite advances in surgical and medical management, the overall incidence of PoAF has not changed significantly, partly because of the limited understanding of mechanisms underlying acute surgery-related factors, such as myocardial injury, inflammation, sympathetic activation, and oxidative stress, which play an important role in the initiation of PoAF, whereas a preexisting atrial substrate appears to be more important in the maintenance of this dysrhythmia. Thus, in a majority of patients, PoAF becomes a manifestation of an underlying arrhythmogenic substrate that is unmasked after acute surgical stress. As such, the ability to identify which patients have this proarrhythmic substrate and are, therefore, at high risk for developing AF postoperatively, is important for the improved selection for prophylactic interventions, closer monitoring for complications, and establishing the probability of AF in the long term. This review highlights the role of the underlying substrate in promoting PoAF, proposed mechanisms, and the potential role of serum biomarkers to identify patients at risk for PoAF.
From the *Sheikh Khalifa bin Hamad Al Thani Center for Integrative Research on Cardiovascular Aging (CIRCA), Aurora University of Wisconsin Medical Group, Aurora Research Institute, Aurora Health Care, Milwaukee, WI; †University of Missouri-Columbia School of Medicine, Columbia, MO; ‡Aurora Medical Group – Cardiovascular and Thoracic Surgery, Aurora St. Luke’s Medical Center, Milwaukee, WI; and §Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, Milwaukee, WI.
Drs. Jahangir and Mirza’s research effort was supported in part by National Heart, Lung, and Blood Institute Grants (RO1 HL101240 and R01 HL089542) and intramural Cardiovascular Medicine and Surgery Research support from the Aurora Research Institute and Aurora Foundation.
Disclosure: The authors have no conflicts of interest to report.
Correspondence: Arshad Jahangir, MD, Center for Integrative Research on Cardiovascular Aging, Aurora Health Care, 2801 W. Kinnickinnic River Parkway, #840, Milwaukee, WI 53215. E-mail: email@example.com.