Postoperative atrial fibrillation


 * Associate Editor(s)-In-Chief: ; Varun Kumar, M.B.B.S.

Overview
The incidence of atrial fibrillation post-CABG is between 20% and 50%. Predictors of post-operative AF include advanced age, history of COPD, valvular heart disease, left atrial enlargement, peri-operative heart failure and discontinuation of either beta blocker or ACE inhibitors before or after surgery, pericarditis and elevated postoperative adrenergic tone. Paroxysmal form of AF is common post-operatively and is usually self-limiting with sinus rhythm resuming by 6-8 weeks post-surgery in more than 90% of patients. Pre-treatment with either digoxin or verapamil has not shown to prevent postoperative AF. In hemodynamically unstable patients, AV nodal blocking agents such as short-acting beta-blockers, nondihydropyridine CCBs or intravenous amiodarone has shown to improve hemodynamics in patients with post-operative AF. Post-CABG, there is an increased risk of stroke; hence, heparin or oral anticoagulation may be appropriate if post-op AF persists for longer than 48-hours.

==ACCF/AHA/HRS 2011 Guidelines- Postoperative AF (DO NOT EDIT) == {{cquote|

Class I
1. Unless contraindicated, treatment with an oral beta blocker to prevent postoperative AF is recommended for patients undergoing cardiac surgery. (Level of Evidence: A)

2. Administration of AV nodal blocking agents is recommended to achieve rate control in patients who develop postoperative AF. (Level of Evidence: B)

Class IIa
1. Preoperative administration of amiodarone] reduces the incidence of AF in patients undergoing cardiac surgery and represents appropriate prophylactic therapy for patients at high risk for postoperative AF. (Level of Evidence: A)

2. It is reasonable to restore sinus rhythm by pharmacological cardioversion with ibutilide or direct current cardioversion in patients who develop postoperative AF as advised for nonsurgical patients. (Level of Evidence: B)

3. It is reasonable to administer antiarrhythmic medications in an attempt to maintain sinus rhythm in patients with recurrent or refractory postoperative AF, as recommended for other patients who develop AF. (Level of Evidence: B)

4. It is reasonable to administer antithrombotic medication in patients who develop postoperative AF, as recommended for nonsurgical patients. (Level of Evidence: B)

Class IIb
1. Prophylactic administration of sotalol may be considered for patients at risk of developing AF following cardiac surgery. (Level of Evidence: B)}}

Vote on and Suggest Revisions to the Current Guidelines

 * The AF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines

Guideline Resources

 * ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation


 * 2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation


 * ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter