Postoperative atrial fibrillation: new directions in prevention and treatment

Postoperative atrial fibrillation (POAF) is the most common and vexing complication of cardiac surgeries in adults. The consequences of this dysrhythmia are numerous and include hemodynamic instability, increased risk for embolic stroke, increased length of hospital stay, increased cost of hospitalization, significant resource utilization, and decreased long-term survival. While some progress has been made in prevention of POAF, the multiple mechanisms involved in its genesis are yet to be elucidated. This article reviews our current understanding of these mechanisms, predictors of POAF, drug therapy for prevention and treatment, and new uses for pacing and internal cardioversion for the prevention and treatment of POAF.