• Simon Pecha, Paulus Kirchhof, and Bruno Reissmann.
• University Heart & Vascular Center Hamburg, Department of Cardiology; Institute of Cardiovascular Sciences, University of Birmingham, UK.
• Dtsch Arztebl Int. 2023 Aug 21; 120 (33-34): 564574564-574.

BackgroundPerioperative arrhythmias are common depending on the type of the operation and can increase morbidity and mortality.MethodsThis review is based on pertinent publications retrieved by a selective search in PubMed, as well as the relevant European guidelines.ResultsArrhythmias are seen in more than 90% of cardiac operations; they are usually transient and often asymptomatic. The risk factors for arrhythmia include ion channel diseases, old age, structural heart disease, cardiac surgery, noncardiac surgery with major fluid shifts, and pulmonary resection. The full spectrum of supraventricular and ventricular arrhythmias can arise perioperatively. Correct ECG interpretation, consideration of the arrhythmia in the overall clinical context, and an understanding of its causes, pathophysiology, and options for effective treatment are critically important. According to a meta-analysis, betablockers lower the risk of perioperative atrial fibrillation (OR = 0.56; 95% confidence interval: [0.35; 0.91]). If anticoagulant treatment is not interrupted for surgery, there is less bleeding with direct oral anticoagulants than with vitamin K antagonists (relative risk: 0.62 [0.47; 0.82]). Moreover, clinical follow-up is important, especially for patients with new-onset atrial fibrillation or heart failure.ConclusionThe identification of high-risk patients and the provision of individualized perioperative monitoring are essential aspects of patient safety. Outpatient cardiological follow-up can improve outcomes.

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