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J Thorac Cardiovasc Surg 2004;127:311-313
© 2004 The American Association for Thoracic Surgery

Editorial

New-onset postoperative atrial fibrillation: A riddle wrapped in a mystery inside an enigma

^a Division of Cardiothoracic Surgery, Departments of Surgery and Physiology, University of Massachusetts, Worcester, Mass, USA

Received for publication March 26, 2003; revisions received April 8, 2003; accepted for publication April 24, 2003.

^* Address for reprints: Adam E. Saltman, MD, PhD, Division of CT Surgery, 55 Lake Avenue North, S3-747, Worcester, MA 01655, USA
adam.saltman@umassmed.edu

The first 20% of the full text of this article appears below.

An appendix of 24 key references is available online.

 

Postoperative new-onset atrial fibrillation (PAF) remains the most common and vexing problem confronting cardiac surgeons. It afflicts as many as 40% of patients undergoing coronary and valve surgery and has been refractory to many attempted methods of prevention, both pharmacologic and nonpharmacologic. In this issue of the Journal, Melo and colleagues¹ have described a simple, quick, and effective adjunct procedure applied at the time of the operation that appears to halve the incidence of PAF.

Although these authors have elegantly described a method that resulted in a 58% reduction in the incidence of PAF, what is most interesting is that neither this study nor any of those that have preceded it over the last 40 years has demonstrated a prophylaxis that completely prevents PAF. Why is this? Most likely it is our poor understanding of the mechanism underlying PAF: we simply do not know what causes this phenomenon and therefore have been unable to make meaningful and effective progress against it.

A review of electrophysiologic basics should prove helpful. Atrial fibrillation is a reentrant arrhythmia. For any reentrant arrhythmia to occur, 2 conditions must exist: there must be an initiating event that sets up the reentrant circuit, and . . . [Full Text of this Article]