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New-onset atrial fibrillation: an update

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Abstract

New-onset atrial fibrillation (NOAF) is the most common perioperative complication of heart surgery, typically occurring in the perioperative period. NOAF commonly occurs in patients who are elderly, or have left atrial enlargement, or left ventricular hypertrophy. Various factors have been identified as being involved in the development of NOAF, and numerous approaches have been proposed for its prevention and treatment. Risk factors include diabetes, obesity, and metabolic syndrome. For prevention of NOAF, β-blockers and amiodarone are particularly effective and are recommended by guidelines. NOAF can be treated by rhythm/rate control, and antithrombotic therapy. Treatment is required in patients with decreased cardiac function, a heart rate exceeding 130 beats/min, or persistent NOAF lasting for ≥ 48 h. It is anticipated that anticoagulant therapies, as well as hemodynamic management, will also play a major role in the management of NOAF. When using warfarin as an anticoagulant, its dose should be adjusted based on PT-INR. PT-INR should be controlled between 2.0 and 3.0 in patients aged < 70 years and between 1.6 and 2.6 in those aged ≥ 70 years. Rate control combined with antithrombotic therapies for NOAF is expected to contribute to further advances in treatment and improvement of survival.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Clinic, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka, 410-2295, Japan

    Takeshi Omae

  2. Department of Anesthesiology and Pain Medicine, School of Medicine, Juntendo University, Tokyo, Japan

    Takeshi Omae & Eiichi Inada

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  1. Takeshi Omae
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  2. Eiichi Inada
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Study conception and design: TO. Data acquisition: TO and EI. Drafting of the article: EI and TO. Critical revision of the article for important intellectual content: TO.

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Correspondence to Takeshi Omae.

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Omae, T., Inada, E. New-onset atrial fibrillation: an update. J Anesth 32, 414–424 (2018). https://doi.org/10.1007/s00540-018-2478-8

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