VALVULAR HEART DISEASE: Edited by Subodh Verma and Bobby YanagawaThe more you look, the more you find atrial fibrillation – nowhere to hideHa, Andrew C.T.a; Verma, Atulb,c,d; Mazer, C. Davidc,e; Yanagawa, Bobbyb,c,f; Verma, Subodhb,c,fAuthor Information aPeter Munk Cardiac Centre, University Health Network bDepartment of Surgery, University of Toronto cLi Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto dDivision of Cardiology, Southlake Regional Health Centre, Newmarket eDepartment of Anesthesia fDivision of Cardiac Surgery, St. Michael's Hospital, Toronto, Canada Correspondence to Dr Andrew C.T. Ha, MD, Division of Cardiology, Toronto General Hospital, University Health Network, 200 Elizabeth Street 3GW-558A, Toronto, ON, Canada. Tel: +1 416 340 5206; fax: +1 416 340 3340; e-mail: [email protected] Current Opinion in Cardiology: March 2019 - Volume 34 - Issue 2 - p 140-146 doi: 10.1097/HCO.0000000000000591 Buy Metrics Abstract Purpose of review We provide an updated review on the incidence of postoperative atrial fibrillation (POAF) after cardiac surgery as determined by enhanced cardiac rhythm monitoring technology and provide a rationale for why a more aggressive detection approach for POAF may be clinically useful. Recent findings Most of the published literature had focused on the in-hospital incidence of POAF after cardiac surgery. However, recent studies using continuous cardiac rhythm technologies revealed that the incidence of POAF during the postdischarge, subacute (<1 month) phase could be as high as 28%. This is a clinically relevant finding since that POAF is linked with occurrence of future, ‘late’ atrial fibrillation, and adverse clinical outcomes even beyond 1 year after cardiac surgery. Furthermore, the role of oral anticoagulation is still not well established for cardiac surgical patients with POAF because of lack of randomized trials specifically designed for this patient population. Summary Emerging data suggest that POAF after cardiac surgery is not a transient, self-resolving phenomenon. Rather, its occurrence is associated with future risk of atrial fibrillation and long-term adverse outcomes such as stroke and death. This highlights the potential importance of enhanced cardiac rhythm monitoring to refine prognostic stratification in this high-risk patient population. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.