Postoperative Atrial Fibrillation after Cardiac Surgery: A Review of Risk Factors, Clinical Outcomes, and Management Strategies

Postoperative atrial fibrillation (POAF) is the most common arrhythmia following cardiac surgery and is associated with increased morbidity, prolonged hospitalization, and higher long-term risks of stroke, heart failure, and mortality. Once considered a transient and benign condition, POAF is now recognized as a clinically significant complication with lasting prognostic implications. This narrative review summarizes the current evidence on the epidemiology, risk factors, pathophysiology, clinical consequences, and management strategies of POAF. It highlights both pharmacological and non-pharmacological preventive measures, including beta-blockers, amiodarone, and posterior pericardiotomy, while also examining the ongoing controversy surrounding anticoagulation therapy in the postoperative setting. Current guideline recommendations for anticoagulation remain inconsistent, largely due to limited high-quality evidence and the absence of validated risk stratification tools tailored to surgical patients. Future research should focus on refining predictive models such as the CHA₂DS₂-VASc score and generating robust randomized data to inform treatment decisions, especially concerning anticoagulation. Recognizing POAF as a marker of long-term cardiovascular risk is essential to improving outcomes and guiding individualized postoperative care.