Prophylaxis and management of postoperative atrial fibrillation

Abstract

Atrial fibrillation (AF) is the most common cardiac arrhythmia seen after cardiac surgery. It is associated with prolongation of hospital stay, postoperative complications, stroke, mortality, and increased hospital cost. Several prevention strategies have been proven effective in reducing postoperative AF; in addition, active prevention of postoperative AF is associated with a decrease in the length of hospital stay and a reduction trend in hospital costs. In patients with postoperative AF, restoration and maintenance of sinus rhythm and rate control are adequate treatment alternatives in the majority of cases. In severely symptomatic or hemodynamically compromised patients urgent cardioversion is needed. Adequate oral anticoagulation may be indicated for a limited period of time.

Propafenone for the Prevention of Atrial Tachyarrhythmias After Cardiac Surgery: A Randomized, Double-blind Placebo-controlled Trial

“…Statistics . Assuming a 40% frequency of occurrence of an end‐point arrhythmia after placebo, 2 , 5 , 6 , 7 , 8 a 20% frequency of occurrence after propafenone, and a dropout rate of 20%, and using α = 0.05 and β = 0.20 (power of 80%), a required sample size of ~120 in each group was calculated (two‐sided Fisher's exact test). In order to examine the association between CYP2D6 polymorphism and the efficacy of propafenone, the PM and IM groups were combined, as the numbers of PMs and IMs were small.…”

“…Patients undergoing CABG alone have a lower incidence of postoperative atrial fibrillation (25%) than those undergoing valve surgery (35%) or combined CABG‐valve operations (45–60%) 2 . Postoperative atrial fibrillation and other atrial tachyarrhythmias are associated with prolongation of hospital stay, postoperative complications, stroke, mortality, and higher hospital costs as compared with patients who do not develop arrhythmias 2 , 3 , 4 , 5 …”

The effect of nebivolol on P wave duration and dispersion in patients with Behçet’s disease; a prospective single-arm controlled study

“…Beta-blockers enhance ventricular filling, lengthen duration of diastole, decrease atrial pressure and dilatation, reduce atrial ischemia and fibrosis and thereby may improve stretch related arrhythmogenic mechanisms (39). Consistent with this data, beta-blockers have been shown to be effective in prevention of postoperative AF, in adrenergically mediated AF, and in reducing relapse rates of AF following cardioversion (40)(41)(42). BD patients have been found to have increased sympathetic and decreased parasympathetic modulation (43).…”

Amiodarone Use to Prevent Postoperative Atrial Fibrillation After Cardiac Surgery

“…7 Magnesium is a cofactor with the sodium-potassium adenosine triphosphatase, which plays a role in myocardial transmembrane function. 20 This regulates the sodium/potassium gradients; therefore, magnesium should be monitored and regulated with the same urgency as potassium.…”

“…The authors concluded that preoperative magnesium was helpful in preventing POAF. 7 Therefore, the combination of magnesium and amiodarone seems to reduce the incidence of POAF. This needs further research as well.…”