Atrial fibrillation affects approximately 3 million people in the United States and creates a huge burden on the health care system, both in terms of morbidity, mortality, and cost.1 The prevalence of atrial fibrillation rises sharply with increases in age. It is estimated that 8% of people above 70 years of age have atrial fibrillation.2-4 Atrial fibrillation has long been recognized as a powerful risk factor for stroke,5 heart failure,6 and mortality.7Advancing age amplifies the risk of all of these sequelae of atrial fibrillation.8
As a subset, post-operative atrial fibrillation (POAF) after cardiac surgery is a common entity that is associated with significant morbidity and increased long-term mortality.9-11 POAF in the setting of coronary artery bypass graft surgery CABG has been associated with increases in health care costs estimated around $10000 per patient affected.12 Procedural risk factors of post-operative AF include valve surgery, pulmonary vein venting, bicaval venous cannulation, and longer cross-clamp times.10 Patient risk factors for POAF include male gender, renal dysfunction, congestive heart failure, and left atrial enlargement,10 the most powerful predictor, however, remains age.13,14 As the number of elderly patients undergoing surgery increases, there has been more interest in investigating the predictors and sequelae of post-operative atrial fibrillation. The search for cost-effective, efficacious, and safe preventive therapies in high-risk patients is increasingly important.
Credits: Prashant Bhave MD; Rod Passman MD, MSCE