Atrial fibrillation and revascularization procedures: clinical and prognostic significance. Incidence, predictors, treatment, and long-term outcome.

Atrial fibrillation is the most common disorder of cardiac rhythm. In spite of simplicity of diagnosis, patients with atrial fibrillation are difficult to treat. In the recent years with the description of the phenomenon called remodelling, it has been possible to better define the principal mechanisms responsible for initiation, maintenance and, in some instances, termination of atrial fibrillation. Electrical, mechanical and anatomical remodelling indicate those alterations that, once established, may baffle any attempt to restore sinus rhythm. Atrial fibrosis is probably the most critical component of the remodelling process and appears to be mediated by several factors. Several kinds of arrhythmias, especially ventricular ones and conduction disturbances, can occur during percutaneous coronary interventions (PCI), resulting from excess catheter manipulation, intracoronary dye injection, new ischemic events, or reperfusion injury. Supraventricular arrhythmias, including atrial flutter and atrial fibrillation (AF), may also occur during or after PCI, as a complication or a sequel of the revascularisation procedure. Also post operative AF is a common complication of coronary artery bypass surgery (CABG), occurring in 5-40% of patients during the first postoperative week, depending on definitions and methods of detection. Experimental and clinical data will be discussed here.