Predicting postoperative atrial fibrillation after off-pump coronary artery bypass surgery—an ongoing story

Despite significant advancements in cardiac surgery, perfusion techniques, anaesthesia and intensive care over the past few decades, postoperative atrial fibrillation (POAF) remains the most common complication after cardiac surgery, with varying incidence depending on the type of procedure.The incidence of POAF in isolated coronary artery bypass grafting (CABG) ranges from 13-33% (1-5).In patients undergoing isolated off-pump coronary artery bypass grafting (OPCABG), the incidence of POAF ranges from 8-20% (1,2,6-8).T h e p a t h o g e n e s i s o f P O A F i s i n c o m p l e t e l y understood and likely involves interplay between preexisting physiological components and the postoperative inflammatory processes.Understanding the complex pathophysiological processes and dynamic changes of atrial fibrillation (AF)-associated inflammation might help to identify specific anti-inflammatory strategies for the prevention of AF (9).Effective prophylaxis and management of POAF is necessary to reduce adverse outcomes.Previous studies have recognized multiple risk factors for POAF after CABG.These include older age, renal failure, impaired left ventricular ejection fraction, diabetes mellitus, chronic obstructive pulmonary disease, use of cardiopulmonary bypass and left atrial size (1,5,6,10,11).Although POAF after cardiac surgery was historically thought to be benign and self-limiting, several studies have now shown that it is associated with a substantial risk for adverse outcomes, including