Postoperative inflammatory reaction and atrial fibrillation: simple correlation or causation?

Atrial fibrillation after cardiac operations is a source of morbidity and resource consumption. This systematic review of literature analyzes the current evidence on its pathophysiologic link with the systemic inflammatory response elicited by surgery and cardiopulmonary bypass. Meta-analysis of randomized studies on the effect of off-pump surgery or statin pre-treatment on the incidence of atrial fibrillation was performed. The concept of inflammation as a pathophysiologic determinant of postoperative atrial fibrillation is supported by the literature. The modulation of post-cardiopulmonary bypass systemic inflammation will probably represent a major therapeutic goal in the prevention of postoperative atrial fibrillation. Statins seem to be the most promising pharmacological strategy.