Fibrilación auricular posoperatoria. ¿Un lobo con piel de cordero?

Since an early age of heart surgery, atrial fibrillation has been a frequent companion of the postoperative period, and its decline is not to be expected in the near future.The interpretation of its clinical significance has changed in recent years, after knowing its recurrent trend and its association with serious immediate and long-term complications.This fact unveils a new challenge, as it is no longer a minor problem of consideration restricted to the perioperative period and has become a topic of concern and follow-upin the distant future, still with uncertainties as to its evolution and management.The effective prophylaxis of this arrhythmia has been difficult by the multiplicity of risk factors and the intricate of its genesis, added to the increasing age of the patients involved, the greater complexity of the procedures, the possible side effects of the drugs used and the absence of a reliable predictive algorithm that could allow to rationalizing preventive measures.In addition, many recommendations from current clinical practice guidelines are based on information obtained from studies in primary atrial fibrillation, so their adoption in the heart surgery scenario has been less than desirable.All these aspects are analyzed in this review, which ends with directives for the practical management of the arrhythmia in the perioperative environment.