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INTRODUCTION
Atrial fibrillation (AF) is among the most frequent arrhythmias, with an estimated global prevalence of
more than 33 million cases; within the United States, the estimated AF prevalence ranges from 2.7 to 6.1
million cases . For the North American population, increased AF incidence has been associated with
[1]
advancing age, male sex, and Caucasian race. Other known AF cardiac-related risk factors include the
presence of coronary artery disease, hypertensive heart disease, and valvular disease. Additionally, non-
cardiac-related diseases have been associated with increased AF, including diabetes, obesity, and chronic
[2]
kidney disease . For patients with a history of AF, there is a heightened risk for adverse post-cardiac clinical
outcomes, including recurrent AF, embolization, myocardial infarction, stroke, and mortality.

As one of the most common post-cardiac surgery complications, AF incidence has been reported ranging
from 10% to 40%; moreover, it is associated with a variety of other post-operative adverse outcomes .
[3]
Specifically, post-operative AF (POAF) following cardiac surgery has been associated with increased
mortality, morbidity, readmission, and overall length of stay.

Recently, there has been a rise in thoracic aortic aneurysms (TAA) incidence reportedly; correspondingly,
there has been an increased interest in the use of aortic repair procedures for TAA rupture/dissection
patients . Given the increased TAA prevalence and treatment rates, it appears timely to review the
[4-6]
documented associations between AF and TAA patients’ outcomes.

METHODS
As of September 6, 2021, a comprehensive PubMed literature review was performed. For this Medline
search, the extremely broad-based MeSH terms used were “thoracic aortic aneurysm” and “atrial
fibrillation”. All initial search articles identified had their abstracts critically appraised by two co-authors
(Sohaib Agha and Ashutosh Yaligar) to determine direct relevance to this TAA procedural pre-/post-
operative AF topic. Findings from all relevant articles were extracted and summarized. All included articles’
references were also carefully reviewed. Additionally, a Web of Science backward PMID citation search was
performed for each included article; all citations were reviewed for potential inclusion based on relevance
criteria also. Since only eight directly applicable articles were identified for qualitative analysis, this
exhaustive Medline review was intended to present the latest scientific findings available on this topic
[Figure 1].

THORACIC AORTIC ANEURYSM RUPTURE/DISSECTION AND SURGICAL
INTERVENTIONS
TAAs are usually asymptomatic until a certain threshold size is reached; at a certain point, the risk of TAA
dissection or rupture increases. Usually presenting emergently, the complications of TAA rupture and/or
[7]
dissection carry a high morbidity and mortality rate . According to current TAA literature regarding TAA
presentation and/or TAA complications of aortic dissections, the surgical intervention and/or management
utilized will be dependent upon the anatomical location of the TAA and whether or not there is a
concurrent rupture/dissection. In most cases, surgical intervention involves resection and replacement of
the dissected or torn aortic segment; very commonly, these ruptures and dissections present as a surgical
emergency.

The DISSECT system has been established to guide clinicians to optimize the management of aortic
[8]
dissections based upon location, symptom onset, duration of time, and other associated risk factors . Based
on DISSECT six characteristics (i.e., disease duration, location of intimal tear, dissected aorta size, aortic