Independent predictors of postoperative atrial fibrillation

An interesting study performed by Choi et al. [1] concluded that a low left ventricular ejection fraction (LVEF), highest C-reactive protein (CRP) before the onset of atrial fibrillation (AF), vasopressor therapy and packed red blood cell (pRBC) transfusion remained as independent predictors of postoperative AF. There has been no definitive cause for postoperative AF identified. Large shifts in fluids, pericarditis and changes in autonomic nervous system have been implicated. Inflammation triggers and maintains AF. Studies have demonstrated an association between AF and CRP concentration [2]. CRP concentration is elevated in patients with left atrial dysfunction without AF, and atrial dysfunction itself can trigger AF after surgery [3]. Prophylactic usage of beta blockers, amiodarone, corticosteroids and statins has reduced the incidence of postoperative AF [4,5]. These medications should be considered in postoperative patients with low LVEF, increased CRP concentration and those receiving vasopressor therapy and increased pRBC transfusion. Authors can use this study or conduct larger trials to identify risk calculator for postoperative AF.