Perioperative challenges of atrial fibrillationPhilip, Ivan; Berroëta, Clarisse; Leblanc, IsabelleCurrent Opinion in Anesthesiology: June 2014 - Volume 27 - Issue 3 - p 344–352 doi: 10.1097/ACO.0000000000000070 ANESTHESIA AND MEDICAL DISEASE: Edited by Natalie Holt Abstract Author Information Purpose of review The management of atrial fibrillation has seen marked changes in recent years. This is the result of better knowledge of the pathophysiology and risks factors for atrial fibrillation, better stratification for thromboembolic and bleeding risks, changing practices in anticoagulation management, and the development of new antiarrhythmic drugs. This article focuses on these new issues, with particular attention to their relevance in the perioperative period. Recent findings Improved understanding of the interaction between predisposing factors and the pathophysiological mechanisms of atrial fibrillation is changing management strategies. Preoperative identification of patients at risk for postoperative atrial fibrillation (POAF) is important so that measures such as ß-blockade may be introduced to prevent its occurrence. When POAF does occur, cardioversion is preferred in unstable patients and amiodarone is the most commonly used drug. Owing to the transient nature of POAF and excessive bleeding risk immediately postsurgery, anticoagulation should be used with caution in these patients. The perioperative management of patients on chronic oral anticoagulants is guided by weighing the risk of thromboembolic complications against the risk surgical bleeding. Risk stratification scoring systems and published guidelines facilitate decision-making. New oral anticoagulants offer potentially improved safety profiles over traditional agents; however, their optimal management in the perioperative period remains unknown. Summary Better knowledge of the pathophysiology of atrial fibrillation and improved awareness of the risks associated with this frequent arrhythmia are continuing to improve the management of patients with chronic atrial fibrillation and new-onset atrial fibrillation in the perioperative period. As with most complex disease processes, treatment decisions must be individualized for each patient and clinical context. Service d’Anesthésie, Institut Mutualiste Montsouris, Paris Cédex, France Correspondence to Ivan Philip, Service d’Anesthésie, Institut Mutualiste Montsouris, Boulevard Jourdan, 75674 Paris Cédex 14, France. Tel: +33 1 56616263; fax: +33 1 56616663; e-mail: firstname.lastname@example.org © 2014 Lippincott Williams & Wilkins, Inc.