Postoperative Atrial Fibrillation in Cardiac Surgery

Postoperative atrial fibrillation (POAF) is the most frequent arrhythmic complication following cardiac surgery, affecting up to 60 per cent of patients. It typically arises between the second and fourth postoperative days and is driven by a complex interplay of factors, including atrial remodelling, pericardial inflammation, oxidative stress induced by cardiopulmonary bypass and ischaemia–reperfusion, and autonomic imbalance. Advanced age, enlarged left atrial size, impaired ventricular function and comorbidities such as hypertension and diabetes further predispose individuals to POAF. Clinically, the onset of POAF is associated with increased risk of stroke, prolonged intensive care and hospital stay, acute kidney injury and higher short- and long-term mortality. Despite multiple pharmacological prophylaxis strategies—ranging from β-blockers and anti-inflammatory agents to antioxidant supplements—incidence remains high and prevention suboptimal. Emerging approaches aim to personalise risk stratification through biomarker profiling and to mitigate arrhythmogenesis by targeting specific molecular pathways or modifying surgical techniques. Improved understanding of the cellular and immunological drivers of POAF is essential to refine preventive measures and reduce its global health and economic burden.

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Postoperative Atrial Fibrillation in Cardiac Surgery publication trend

The graph below shows the total number of articles in postoperative atrial fibrillation in cardiac surgery across all publications each year (not limited to Nature Index journals).

Technical terms

Postoperative atrial fibrillation (POAF): New-onset atrial fibrillation occurring after cardiac surgery.

Cardiopulmonary bypass: Mechanical support of heart and lungs during surgery that can trigger systemic inflammation and oxidative stress.

Inflammasome: Immune complex, notably NLRP3, that initiates and amplifies inflammatory cytokine release.

Exosomes: Nano-sized extracellular vesicles containing proteins and RNA, used experimentally to modulate tissue repair and inflammation.

Cardiac denervation: Surgical interruption of autonomic nerves (for example, ligament of Marshall division) to reduce arrhythmogenic stimuli.

Beta-blockers: Medications that block β-adrenergic receptors to slow heart rate and reduce arrhythmic risk, often used around the time of surgery.

References

1. Inactivation of the NLRP3 inflammasome mediates exosome-based prevention of atrial fibrillation. Theranostics (2024).
2. Partial Cardiac Denervation to Prevent Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting. JAMA Cardiology (2025).
3. Maintenance of beta-blockers and cardiac surgery-related outcomes: a prospective propensity-matched multicentre analysis. British Journal of Anaesthesia (2024).
4. Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery. Pharmacology & Therapeutics (2015).