Atrial fibrillation (AF) and atrial flutter occur frequently after cardiac surgery. The development of these atrial arrhythmias prolongs hospital stay and is associated with worse long-term prognosis. Other supraventricular arrhythmias, including atrial arrhythmias such as atrioventricular nodal re-entrant tachycardia, are not common in this setting. (See "Atrioventricular nodal reentrant tachycardia".)
This topic will review the pathogenesis, predictors, clinical course, prevention, and management of AF and atrial flutter occurring after cardiac surgery. Most of the observations on atrial arrhythmias come from patients who developed atrial fibrillation. Our approach to patients with atrial flutter is similar, unless otherwise specified.
Ventricular tachyarrhythmias after cardiac surgery and arrhythmias after cardiac transplantation are discussed separately. (See "Early cardiac complications of coronary artery bypass graft surgery", section on 'Ventricular tachyarrhythmias' and "Arrhythmias following cardiac transplantation".)
Atrial fibrillation (AF) and atrial flutter can occur early in the postoperative period or as a late complication of cardiac surgery. A discussion of the mechanisms of AF in the general population is found elsewhere. (See "Mechanisms of atrial fibrillation".)
Postoperative AF is likely related to a combination of factors. These include pre-existing degenerative changes in the atrial myocardium and perioperative conditions that result in abnormalities of several electrophysiologic parameters that promote the development of AF, such as dispersion of atrial refractoriness, increase in phase 3 depolarization, enhanced automaticity, increased interatrial conduction time, and decreased conduction velocity and atrial transmembrane potentials [1-5]. (See "The electrocardiogram in atrial fibrillation".)