Pericardial Effusion Provoking Atrial Fibrillation After Cardiac Surgery: JACC Review Topic of the Week

J Am Coll Cardiol. 2022 Jun 28;79(25):2529-2539. doi: 10.1016/j.jacc.2022.04.029.


Postoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery. Patients who develop POAF are more likely to experience adverse outcomes, including increased rates of death, stroke, heart failure, and hospitalizations, and higher hospital costs. Understanding the mechanisms underlying POAF is important to improve patients' outcome and optimize health systems' efficiency. Beyond classic pathogenic hypotheses, emerging evidence suggests that postoperative pericardial effusion and localized pericardial inflammation may trigger POAF. This hypothesis is supported by data from nonhuman animal models and a growing body of evidence showing that reducing postoperative pericardial effusion might reduce POAF incidence. In this review, we summarize the classic pathophysiology theories of POAF following cardiac surgery and discuss new etiologic mechanisms with a specific focus on the role of pericardial effusion and inflammation.

Keywords: POAF; cardiac surgery; etiology; inflammation; pericardial effusion; postoperative atrial fibrillation.

Publication types

  • Review

MeSH terms

  • Atrial Fibrillation* / epidemiology
  • Atrial Fibrillation* / etiology
  • Atrial Fibrillation* / prevention & control
  • Cardiac Surgical Procedures* / adverse effects
  • Humans
  • Inflammation / etiology
  • Pericardial Effusion* / epidemiology
  • Pericardial Effusion* / etiology
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Risk Factors
  • Treatment Outcome