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Bilfinger. Vessel Plus 2022;6:40 Vessel Plus
DOI: 10.20517/2574-1209.2021.118

Commentary Open Access

Daily atrial fibrillation issues: the view-point of a

practicing surgeon

Thomas V. Bilfinger
Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA.

Correspondence to: Prof. Thomas V. Bilfinger, Renaissance School of Medicine, Stony Brook University, HSC T-19 Rm 80, Stony
Brook, NY 11794, USA. E-mail: Thomas.bilfinger@stonybrookmedicine.edu

How to cite this article: Bilfinger TV. Daily atrial fibrillation issues: the view-point of a practicing surgeon. Vessel Plus 2022;6:40.
https://dx.doi.org/10.20517/2574-1209.2021.118

Received: 24 Aug 2021 Revised: 24 Oct 2021 Accepted: 5 Nov 2021 Published: 1 Jul 2022

Academic Editor: Frank W. Sellke Copy Editor: Haixia Wang Production Editor: Haixia Wang

Abstract
Atrial Fibrillation (AF) is encountered daily by the cardiac surgeon. How to deal with a patient with pre existing AF
who is on anticoagulation taking into account urgency, type of anticoagulation and procedure planned are some of
the daily considerations encountered. When to start anticoagulation and other pharmacotherapy after the
occurrence of post-op atrial fibrillation and the use of ablative therapies in view of bleeding and other
complications are daily judgement calls made by surgeons. Whom to offer combined interventions are decisions
the surgeon faces daily. While guidelines help in broad strokes, there is little help for individual situations which is
due to structural problems and absence of universal definitions resulting in the lack of granular data needed for
practical individualized daily decision making.

Keywords: Cardiac surgery, atrial fibrillation, anticoagulation, antiarrhythmic therapy, surgical ablation, guidelines

INTRODUCTION
Atrial fibrillation (AF) is the most common dysrhythmia that a cardiac surgeon encounters. It is estimated
that 0.4%-1.0% of the general population is afflicted. The presence of AF is highly linked to age and may
exceed 10% in patients > 80 years . Frequency and the effect on outcomes have been studied for the past
[1]
half century. Over this time we have learned that all surgical patients are at risk to experience atrial
fibrillation. We have further learned that despite many technological and procedural improvements the
occurrence of atrial fibrillation and particularly post-operative atrial fibrillation (POAF), has barely

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
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