With more than a third of patients expected to endure the arrhythmia at any given time point, atrial fibrillation after cardiac surgery becomes a vexing problem in the postoperative care of cardiac surgery patients. The impact on patient care covers a spectrum from the more common clinically insignificant sequelae to debilitating embolic events. Despite this, postoperative atrial fibrillation generally masquerades as being insignificant, or at most as an anticipated inherent risk, merely extending one's hospital stay by a few days. As an independent risk factor for stroke, early and late mortality, and being a multibillion dollar strain on the healthcare system annually, postoperative atrial fibrillation is far more flagrant than a mere inherent risk. It is a serious medical quandary, which is not recognized as such. Though complete prevention is unrealistic, a step-wise treatment strategy that incorporates multiple preventative modalities can significantly reduce the impact of postoperative atrial fibrillation on patient care. The aims of this review are to present a brief overview of the arrhythmia’s etiology, risk factors, and preventative strategies to reduce associated morbidities. Newer anticoagulants and the potential role of these drugs on future treatment paradigms are also discussed. 1. Introduction Atrial fibrillation (AF) is the most common arrhythmia and morbidity after cardiac surgery. Though the incidence varies depending on the intensity of monitoring, best estimates suggest that nearly 30% of patients undergoing coronary artery bypass grafting (CABG) surgery, 40% of patients undergoing valvular heart surgery, and more than the half of all patients undergoing combined coronary and valvular procedures will develop the arrhythmia [1, 2]. Although postoperative atrial fibrillation (POAF) is at times dismissed as a nonissue due to its often benign course, POAF remains a serious medical concern. The arrhythmia poses serious risks to patients in the postoperative period and requires countless preventative healthcare expenditure [3–10]. This paper is an up-to-date look into POAF etiology, risk factors, and consequences. Treatment strategies to reduce the incidence of POAF and preventative modalities to minimize risk of the arrhythmia are also discussed. There is currently no single treatment or preventative option for POAF. A systematic approach that is initiated in the preoperative period and continued to the perioperative recovery phase offers the best preventative strategy. Futuristic anticoagulants and their potential impact on hospital
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