Intraoperative Atrial Fibrillation in Non-Cardiac Surgery: A Narrative Review of Risk Factors and Management...

Area of Science:

• Cardiology
• Anesthesiology
• Clinical Medicine

Background:

• Atrial fibrillation (AF) is a common arrhythmia.
• Intraoperative atrial fibrillation (IOAF) during non-cardiac surgery is understudied but linked to increased morbidity and mortality.
• Understanding IOAF is crucial for patient safety in surgical settings.

Purpose of the Study:

• To review and synthesize existing literature on the risk factors and management of IOAF in non-cardiac surgery.
• To identify key domains contributing to IOAF risk.
• To outline current management strategies for IOAF.

Main Methods:

• A narrative review of studies published between 1990 and 2025.
• Databases searched included PubMed, ScienceDirect, and the Cochrane Library.
• Focus on risk factors and management strategies in non-cardiac surgical procedures.

Main Results:

• IOAF prevalence in non-cardiac surgery ranges from 1% to 5%.
• Identified risk factors fall into three domains: patient profile (age, prior AF, heart disease), procedure invasiveness, and acute triggers (hypotension, electrolyte imbalance).
• Management involves assessing hemodynamic stability, addressing triggers, controlling rate/rhythm, and considering anticoagulation (CHA2DS2-VASc score).

Conclusions:

• IOAF in non-cardiac surgery presents significant clinical implications.
• Standardized definitions are essential for advancing research and improving IOAF management.
• Further investigation is needed to optimize care for patients experiencing IOAF during non-cardiac procedures.