Atrial fibrillation after coronary bypass surgery – pathophysiology, resource utilisation and management strategies

Background: With an incidence rate of 30–50%, atrial fibrillation (AF) after bypass surgery continues to be one of the most common complications. The possibilities of haemodynamic instability and thromboembolism necessitate the initiation of antiarrhythmic and anticoagulant therapy. Despite early initiation of therapy, AF can increase post-bypass morbidity and mortality. It can also prolong intensive care unit and hospital stay and further increase resource utilisation. In this article we review the pathophysiology, risk factors, effect on resource utilisation, current prophylactic and therapeutic strategies, and risk-benefit assessment of anticoagulant therapy in post-bypass AF.
Methods: This is a review of the medical literature on post-bypass AF from January 1980 to March 2003. Relevant older references were also reviewed. Clinical and research studies on the mechanisms, pathophysiology, risk factors, complications, resource utilisation, prophylaxis and management were collected from the Medline, Embase, Cinhal and Sigle databases and reviewed.
Conclusion: AF significantly increases complications and resource utilisation after bypass surgery. Prophylactic therapy could significantly reduce the incidence of AF. In AF lasting more than 48 hours, anticoagulant or antiplatelet therapy based on individual risk assessment is recommended.