Perioperative Arrhythmias: Pathophysiology, Risk Stratification, Management, and Emerging Technologies-A Narrative...

Area of Science:

• Cardiology
• Anesthesiology
• Perioperative Medicine

Background:

• Cardiac arrhythmias, particularly postoperative atrial fibrillation (POAF), affect 20-50% of surgical patients, increasing morbidity, mortality, and costs.
• Pathogenesis involves surgical stress, anesthesia, autonomic imbalance, inflammation, and electrolyte issues, limiting single-intervention efficacy.

Purpose of the Study:

• To review current evidence on the pathophysiology, risk stratification, prevention, and management of perioperative cardiac arrhythmias.
• To highlight emerging technologies and emphasize individualized, patient-tailored approaches.

Main Methods:

• A narrative review of literature searched from MEDLINE, Embase, and Cochrane CENTRAL (January 2010-January 2026).
• Prioritization of randomized trials, meta-analyses, and clinical guidelines.

Main Results:

• Contemporary risk stratification combines clinical scores, biomarkers, and ECG parameters; machine learning shows moderate predictive ability (AUC 0.84).
• Prophylaxis (beta-blockers, magnesium, amiodarone, colchicine) and tailored acute management reduce POAF.
• Anticoagulation guided by CHA2DS2-VASc score, though timing and duration need definition.

Conclusions:

• Personalized integration of risk assessment, prophylaxis, monitoring, and management is crucial for reducing arrhythmia-related morbidity.
• Emerging technologies like wearable monitoring and AI-based detection show promise for improved patient outcomes.