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Europace Advance Access published online on October 1, 2008
Europace, doi:10.1093/europace/eun273
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

REVIEW

The significance of preoperative atrial fibrillation in patients undergoing cardiac surgery: preoperative atrial fibrillation—still underestimated opponent

Maciej Banach1,*, Giovanni Mariscalco2, Murat Ugurlucan3, Dimitri P. Mikhailidis4, Marcin Barylski5 and Jacek Rysz5

1 Department of Cardionephrology and Hypertension, Medical University of Lodz, Zeromskiego 113, 90-549 Lodz, Poland; 2 Department of Surgical Sciences, Cardiac Surgery Division, University of Insubria, Varese, Italy; 3 Department of Cardiac Surgery, Rostock University Medical Faculty, Rostock, Germany; 4 Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London, London, UK; 5 Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Lodz, Poland

Atrial fibrillation (AF) has been described as an ‘epidemic’ due to its increasing prevalence in the ageing population. The prevalence of AF in the UK has risen from 0.78% in 1994 to 1.42% in 2006. The pathogenesis of AF seems to be multifactorial, and includes electrical and structural remodelling, and inflammation. As a result of recent developments in invasive cardiology together with improved pharmacological treatments, cardiac surgeons are increasingly operating on elderly patients with very advanced heart disease and other co-existent diseases. Therefore, AF is often present before cardiac surgery, increasing the risk of surgery and the occurrence of postoperative complications. According to available data, preoperative AF (pre-AF) should be considered as a high-risk marker of postoperative complications, which also significantly reduces long-term patient survival. However, although some multivariate models have concluded that pre-AF seems to be an independent predictor of outcome, this does not prove a cause–effect relationship. Therefore, such a link would need to be proven in prospective randomized studies, yet to be undertaken.

Key Words: Cardiac surgery, Complications, Preoperative atrial fibrillation, Predictors, Prognosis

* Corresponding author. Tel: +48 42 636 44 71; fax: +48 42 636 44 71. E-mail address: maciejbanach{at}aol.co.uk

Manuscript submitted 20 August 2008. Accepted after revision 9 September 2008.


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