Atrial fibrillation

Over 2 million people in the Untied States are known to have AF, and this number is expected to rise to 5 to 6 million in the next 50 years. In spite of advances in detection and treatment of AF, it is still associated with significant morbidity and mortality. Treatment currently consists of rhythm management and prevention of embolic events (anticoagulation). Although two strategies of rhythm management exist (heart rate control and heart rhythm control), a distinct advantage of one over the other has not yet been determined. Because of the increasing numbers of patients who have AF in the general population and newer surgical approaches to dealing with AF, the anesthesiologist encounters patients who have AF on an almost daily basis. Fortunately, national and international guidelines exist for the treatment of pre-existing AF and dealing with anticoagulated patients in the perioperative period, clearly indicating whether a patient is adequately managed or not by current standards of practice. With respect to the new development of AF in the perioperative period, cardiac and thoracic surgeries are particularly associated with this phenomenon. Guidelines have been published for the perioperative management of AF after cardiac surgery, and are in accordance with the findings from studies in thoracic surgery. Beta-blockers and amiodarone are strongly recommended for the pre-emptive treatment of AF in high-risk patients, whereas amiodarone and sotalol are the agents of choice in those patients developing AF after surgery not requiring urgent cardioversion. The recent discoveries of properties of statins other than their lipid-lowering abilities has sparked wide interest in the possibility of this family of drugs having a protective role against AF in many scenarios. It remains to be seen whether statins will prove to be adjunct in patients at high risk for AF in the perioperative period.