Current Use of Prophylactic Strategies for Postoperative Atrial Fibrillation: A Survey of Canadian Cardiac Surgeons

Price, Joel; Tee, Rebecca; Lam, Buu Khanh; Hendry, Paul; Green, Martin S.; Rubens, Fraser D.

doi:10.1016/j.athoracsur.2009.03.059

Cited by 26 publications

(15 citation statements)

References 27 publications

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“…44 Despite the evidence supporting the efficacy of prophylactic treatment for POAF, prevention protocols are not routinely implemented in many cardiac surgery centers. 45,46 Cited reasons for non-use include the lack of convincing evidence, the complexity of some drug regimens and the potential risks associated with the proposed drug regimens. The concern with complications and side effects associated with those prophylactic treatments could be alleviated by targeting only high-risk patients, thus achieving the best possible risk benefit ratio of preventive therapy.…”

Section: Introductionmentioning

confidence: 99%

Predicting New-Onset Postoperative Atrial Fibrillation in Cardiac Surgery Patients

Tran

Perry

Dupuis

et al. 2015

Journal of Cardiothoracic and Vascular Anesthesia

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Section: Introductionmentioning

confidence: 99%

Predicting New-Onset Postoperative Atrial Fibrillation in Cardiac Surgery Patients

Tran

Perry

Dupuis

et al. 2015

Journal of Cardiothoracic and Vascular Anesthesia

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“…Despite these evidence‐based recommendations, recent online surveys showed that the use of beta‐blockers and amiodarone for prophylaxis of POAF among Canadian and Scandinavian cardiac surgeons remains less than expected . The main reason for not using beta‐blockers in these surveys was lack of confidence in the efficacy of this approach, while the main reason for not using amiodarone was a perceived increased risk of complications …”

Section: Conventional Therapies For Preventing Poafmentioning

confidence: 99%

“…16,17 Despite these evidence-based recommendations, recent online surveys showed that the use of betablockers and amiodarone for prophylaxis of POAF among Canadian and Scandinavian cardiac surgeons remains less than expected. 18,19 The main reason for not using beta-blockers in these surveys was lack of confidence in the efficacy of this approach, while the main reason for not using amiodarone was a perceived increased risk of complications. 18,19 THE CONCEPT OF LOCAL AMIODARONE DELIVERY TO THE MYOCARDIUM Systemic administration of amiodarone, either oral or intravenous, has several disadvantages including requirement of a loading period, interaction with many other drugs, and associated risk of potentially serious extracardiac side effects, such as thyroid dysfunction, hepatic toxicity, and interstitial pneumonia.…”

Section: Conventional Therapies For Preventing Poafmentioning

confidence: 99%

“…18,19 The main reason for not using beta-blockers in these surveys was lack of confidence in the efficacy of this approach, while the main reason for not using amiodarone was a perceived increased risk of complications. 18,19 THE CONCEPT OF LOCAL AMIODARONE DELIVERY TO THE MYOCARDIUM Systemic administration of amiodarone, either oral or intravenous, has several disadvantages including requirement of a loading period, interaction with many other drugs, and associated risk of potentially serious extracardiac side effects, such as thyroid dysfunction, hepatic toxicity, and interstitial pneumonia. 20,21 These potential systemic side effects of amiodarone are, in part, attributable to the relatively high drug concentrations, the wide distribution in all tissues containing adipose cells, the accumulation in organs such as the liver and lungs, and the long elimination half-life averaging about 58 days.…”

Section: Conventional Therapies For Preventing Poafmentioning

confidence: 99%

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Intrapericardial Amiodarone for the Prevention of Postoperative Atrial Fibrillation

Habbab

Chu

2016

J Card Surg

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Despite probably being the most effective prophylactic drug for postoperative atrial fibrillation (POAF), amiodarone is reserved as a second-line agent because of its potential systemic side effects. Herein, we review the available experimental and clinical trials examining the effectiveness of intrapericardial (IPC) amiodarone administration in preventing POAF which, if confirmed by future studies, can have a significant impact on cardiac surgery practice. doi: 10.1111/jocs.12700 (J Card Surg 2016;31:253-258) Postoperative atrial fibrillation (POAF) is the most frequent arrhythmia encountered after cardiac surgery, with incidence rates varying between 15% and 60%, depending on the type of procedure and the criteria for diagnosis.1 POAF has been reported in up to 15% to 40% of patients after isolated coronary artery bypass grafting (CABG) surgery, in 37 % to 50% after valvular surgery, and in approximately 60% after combined procedures.2,3 The incidence of POAF consistently increases with older age in patients undergoing CABG. 3,4 POAF occurs more frequently within the first few days after surgery, with a peak on postoperative days 2 and 3, and 94% of cases occurring before the end of postoperative day 6. 5,6 Although often self-limiting, POAF is associated with an increased risk of mortality and morbidity.7 Almassi et al. 8 found in a series of 3855 patients undergoing cardiac surgery that patients who developed POAF had significantly higher hospital mortality (6% vs. 3%) and six-month mortality (9% vs. 4%).Current evidence suggests that POAF following CABG is also associated with significantly higher risk of mortality in long-term follow-up. In a retrospective study of 6475 patients undergoing CABG, the development of POAF was not only associated with a greater in-hospital (7.4% vs. 3.4%) mortality but also with a higher four-year mortality (26% vs. 13%).9 A recent meta-analysis that evaluated the long-term survival of POAF versus No-POAF cohorts following coronary bypass surgery in 69,518 patients demonstrated that POAF is associated with significantly higher risk of mortality at 1-, 3-, 5-, and 10-year follow-up.10

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“…In addition, the etiology of POAF is not clearly understood, which can impacts the surgeon's willingness to practice various types of proposed prophylactic treatments. However, recently, prophylaxis has been considered only in high-risk patients, considering the risk-benefit ratio (10).…”

Section: Introductionmentioning

confidence: 99%

Postoperative atrial fibrillation prediction following isolated surgical aortic valve replacement

Iliescu¹

2018

Anatol J Cardiol

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ObjectivePostoperative atrial fibrillation (POAF) is the most common complication following cardiac surgery, with increased risk of stroke and high mortality. Our aim was to identify patients at risk and to design a model that could predict POAF.MethodsIn this single center study, we evaluated 1191 patients requiring isolated surgical aortic valve replacement between January 2000 and June 2014. The patients were followed during the early postoperative period until discharge.ResultsAF occurred in 342 patients (28.71%). Six variables associated with high arrhythmic risk [advanced age, body mass index, tricuspid regurgitation, prolonged ventilation, longer intensive care unit stay, and dilated left atrium (LA; volume ≥35 ml/m2)] were selected to create a multivariate prediction model. This model predicted POAF in 64.7% of cases, with a moderate discriminative power (AUC=0.65; p=0.001; 95% CI, 0.571-0.771). We also developed the CHAID (Chi-square automatic interaction detection) model showing multilevel interactions among risk factors for POAF. Age had the greatest discriminative power, with patients aged >68 years at a higher risk for POAF. In low-risk patients, the subgroup with dilated LA (volume ≥40 ml) was more prone to develop POAF. For the intermediate-risk group, history of AF was the next deciding variable, whereas for the high-risk group, it was tricuspid regurgitation (at least moderate).ConclusionThe multivariate logistic model has an acceptable predictive value. CHAID-derived model is a new tool that could be easily applied to identify patients requiring prophylactic regimens.

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Current Use of Prophylactic Strategies for Postoperative Atrial Fibrillation: A Survey of Canadian Cardiac Surgeons

Cited by 26 publications

References 27 publications

Predicting New-Onset Postoperative Atrial Fibrillation in Cardiac Surgery Patients

Predicting New-Onset Postoperative Atrial Fibrillation in Cardiac Surgery Patients

Intrapericardial Amiodarone for the Prevention of Postoperative Atrial Fibrillation

Postoperative atrial fibrillation prediction following isolated surgical aortic valve replacement

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