Early management of atrial fibrillation in general surgical in-patients

It has been suggested that new-onset atrial fibrillation (AF) in non-cardiac surgical patients should trigger a thorough search for other morbidity. We reviewed our unit's management of new-onset AF to determine whether this target is achieved.

Patients under the care of a general surgeon who developed new-onset AF during their inpatient stay were identified from a prospectively maintained database of surgical in-patients. Their case-notes were reviewed to determine whether a precipitating cause for the AF was sought or identified.

Thirty-one patients developed new-onset AF. Almost half had positive findings on cardiovascular or respiratory system examination and assessment. However, 35% of patients had no respiratory examination, 58% had no cardiovascular examination and 55% had no abdominal examination performed. Eighty-one percent had another underlying complication diagnosed within 24h of the AF. Twenty-six percent had an intra-abdominal collection. Of those with an underlying complication, 52% were not diagnosed at the time of initial assessment for AF. Twenty percent of patients died within 30 days of the AF.

New-onset AF in general surgical patients is associated with considerable morbidity. A thorough clinical evaluation and early involvement of senior surgical staff are recommended.