Perioperative atrial fibrillation after non-cardiac surgery - A narrative review

Perioperative atrial fibrillation (POAF) in non-cardiac surgery (NCS) is a multifactorial condition with significant prognostic implications. This review summarizes current evidence on the incidence, risk factors, pathophysiology, complications, prevention, and management of POAF in NCS. POAF affects around 3% of all patients undergoing NCS, with rates of 10-15% in thoracic procedures. Key risk factors include advanced age, male sex, pre-existing cardiopulmonary diseases, type, duration, and urgency of surgery as well as perioperative inflammation. Pathophysiological mechanisms are not fully understood but may include gap junction uncoupling triggered by inflammation, ischemia, and autonomic imbalance. POAF in NCS is associated with increased risks of stroke, heart failure, progression to chronic atrial fibrillation and mortality. Available data on patient-reported symptoms, functional status and quality of life are sparse. Preventive strategies and treatment options for POAF after NCS are limited and not standardized. Large trials are needed to define the efficacy and safety of anticoagulation, rhythm control and other treatments.