Perioperative Arrhythmias

TY - JOUR

T1 - Perioperative Arrhythmias

AU - Pecha, Simon

AU - Kirchhof, Paulus

AU - Reissmann, Bruno

PY - 2023/8/21

Y1 - 2023/8/21

N2 - BACKGROUND: Perioperative arrhythmias are common depending on the type of the operation and can increase morbidity and mortality.METHODS: This review is based on pertinent publications retrieved by a selective search in PubMed, as well as the relevant European guidelines.RESULTS: Arrhythmias are seen in more than 90% of cardiac operations; they are usually transient and often asymptomatic. The risk factors for arrhythmia include ion channel diseases, old age, structural heart disease, cardiac surgery, noncardiac surgery with major fluid shifts, and pulmonary resection. The full spectrum of supraventricular and ventricular arrhythmias can arise perioperatively. Correct ECG interpretation, consideration of the arrhythmia in the overall clinical context, and an understanding of its causes, pathophysiology, and options for effective treatment are critically important. According to a meta-analysis, betablockers lower the risk of perioperative atrial fibrillation (OR = 0.56; 95% confidence interval: [0.35; 0.91]). If anticoagulant treatment is not interrupted for surgery, there is less bleeding with direct oral anticoagulants than with vitamin K antagonists (relative risk: 0.62 [0.47; 0.82]). Moreover, clinical follow-up is important, especially for patients with new-onset atrial fibrillation or heart failure.CONCLUSION: The identification of high-risk patients and the provision of individualized perioperative monitoring are essential aspects of patient safety. Outpatient cardiological follow-up can improve outcomes.

AB - BACKGROUND: Perioperative arrhythmias are common depending on the type of the operation and can increase morbidity and mortality.METHODS: This review is based on pertinent publications retrieved by a selective search in PubMed, as well as the relevant European guidelines.RESULTS: Arrhythmias are seen in more than 90% of cardiac operations; they are usually transient and often asymptomatic. The risk factors for arrhythmia include ion channel diseases, old age, structural heart disease, cardiac surgery, noncardiac surgery with major fluid shifts, and pulmonary resection. The full spectrum of supraventricular and ventricular arrhythmias can arise perioperatively. Correct ECG interpretation, consideration of the arrhythmia in the overall clinical context, and an understanding of its causes, pathophysiology, and options for effective treatment are critically important. According to a meta-analysis, betablockers lower the risk of perioperative atrial fibrillation (OR = 0.56; 95% confidence interval: [0.35; 0.91]). If anticoagulant treatment is not interrupted for surgery, there is less bleeding with direct oral anticoagulants than with vitamin K antagonists (relative risk: 0.62 [0.47; 0.82]). Moreover, clinical follow-up is important, especially for patients with new-onset atrial fibrillation or heart failure.CONCLUSION: The identification of high-risk patients and the provision of individualized perioperative monitoring are essential aspects of patient safety. Outpatient cardiological follow-up can improve outcomes.

KW - Humans

KW - Atrial Fibrillation/diagnosis

KW - Heart Diseases

KW - Hemorrhage

U2 - 10.3238/arztebl.m2023.0052

DO - 10.3238/arztebl.m2023.0052

M3 - Training articles

C2 - 37097070

VL - 120

SP - 564

EP - 574

JO - DTSCH ARZTEBL INT

JF - DTSCH ARZTEBL INT

SN - 1866-0452

IS - 33-34

ER -