Therapeutic approaches employed in cardiac surgery to manage postoperative atrial fibrillation

Postoperative atrial fibrillation (POAF) is amongst the most common complications following cardiac surgery and often results in prolonged post-surgical hospital stay, stroke, increased mortality and morbidity, and higher medical costs. Many factors are intertwined in the development of this common complication after cardiac surgery such as surgical trauma, left atrial hypertrophy, valvular changes in atrial pressure, pre-existing congestive heart failure, chronic renal failure, or chronic obstructive pulmonary disease (COPD). In addition, POAF is observed to be more common in the elderly, the male gender, and obese patients. Several drugs are known to prevent POAF in cardiac surgery. Despite the great potential that has been done to reduce the incidence of POAF, the incidence of POAF has not changed significantly. In addition, the literature on POAF management is limited. Moreover, although current guidelines advocate antiarrhythmic drugs in the management of POAF after cardiac surgery, they do not completely prevent POAF, so more new interventions should be tested and added to existing known antiarrhythmic drugs. This review aims to compile and compare the most commonly used therapeutic approaches and drugs in the management of POAF, such as beta-blockers, colchicine, amiodarone, onabotulinumtoxinA, atorvastatin, and others, based on their ability to reduce POAF incidence, stroke occurrence and length of hospital stay (LOHS). In addition, we point out the gaps and limitations of clinical research in this area.