Postoperative atrial fibrillation: Difference between revisions

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{{Atrial fibrillation}}
{{Atrial fibrillation}}
{{CMG}}; {{AE}} {{CZ}}; [[Varun Kumar, M.B.B.S.]]
{{CMG}}; {{AE}} {{Anahita}} {{CZ}}; [[Varun Kumar, M.B.B.S.]]


==Overview==
==Overview==
Post-[[surgery|operative]] [[atrial fibrillation]] is common in [[heart|cardiac]] or non-[[heart|cardiac]] [[surgery|surgeries]]. The [[incidence]] of [[atrial fibrillation]] in post-[[coronary artery bypass surgery]] ([[CABG]]) and non-[[heart|cardiac]] [[surgery]] [[patients]] are 20%-50% and 0.4%-12%, respectively. [[pain]] and [[inflammation]] due to [[surgery]], [[hypovolemia]] and [[hypervolemia]], [[anemia]], [[hypoxemia]], [[hypomagnesemia]] and [[hypokalemia]] are some of the known factors in [[pathogenesis]] of [[atrial fibrillation]] after [[surgery]]. Although [[atrial fibrillation]] can develop within any time after [[surgery]], it's [[incidence]] is higher between second and fifth [[surgery|postoperative]] day. [[old age|Advanced age]], [[male]] gender, [[obesity]], history of [[chronic obstructive pulmonary disease]], [[valvular heart disease]] and [[chronic renal failure]] are some of the [[risk factors]] of [[surgery|post operative]] [[atrial fibrillation]]. To address [[surgery|post operative]] [[atrial fibrillation]] there are both [[pharmacology|pharmacological]] and non-[[pharmacology|pharmacological]] [[treatments]]. In [[Hemodynamics|hemodynamically]] unstable [[patients]], [[Atrioventricular node|AV nodal]] blocking agents such as [[Beta blocker|short-acting beta-blockers]], [[CCB|nondihydropyridine CCBs]] or [[Intravenous therapy|intravenous]] [[amiodarone]] have been shown to improve [[Hemodynamics|hemodynamics]] in [[patients]] with post-[[surgery|operative]] [[atrial fibrillation]]. Based on a study, using [[Intravenous therapy|intravenous]] [[analgesics]] in [[patients]] who has pulmonary resection [[surgery]] showed significantly lower rates of [[surgery|postoperative]] [[atrial fibrillation]], compared to the control group.


==Postoperative Atrial fibrillation==
==Postoperative Atrial fibrillation==
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*The [[incidence]] of [[atrial fibrillation]] in post-[[coronary artery bypass surgery]] ([[CABG]]) [[patients]] is between 20% and 50%.<ref name="pmid2502088">Soria R, Guize L, Chretien JM, Le Heuzey JY, Lavergne T, Desnos M et al. (1989) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2502088 [The natural history of 270 cases of Wolff-Parkinson-White syndrome in a survey of the general population].] ''Arch Mal Coeur Vaiss'' 82 (3):331-6. PMID: [http://pubmed.gov/2502088 2502088]</ref><ref name="pmid8379728">Creswell LL, Schuessler RB, Rosenbloom M, Cox JL (1993) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8379728 Hazards of postoperative atrial arrhythmias.] ''Ann Thorac Surg'' 56 (3):539-49. PMID: [http://pubmed.gov/8379728 8379728]</ref><ref name="pmid1682069">Andrews TC, Reimold SC, Berlin JA, Antman EM (1991) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1682069 Prevention of supraventricular arrhythmias after coronary artery bypass surgery. A meta-analysis of randomized control trials.] ''Circulation'' 84 (5 Suppl):III236-44. PMID: [http://pubmed.gov/1682069 1682069]</ref>  
*The [[incidence]] of [[atrial fibrillation]] in post-[[coronary artery bypass surgery]] ([[CABG]]) [[patients]] is between 20% and 50%.<ref name="pmid2502088">Soria R, Guize L, Chretien JM, Le Heuzey JY, Lavergne T, Desnos M et al. (1989) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2502088 [The natural history of 270 cases of Wolff-Parkinson-White syndrome in a survey of the general population].] ''Arch Mal Coeur Vaiss'' 82 (3):331-6. PMID: [http://pubmed.gov/2502088 2502088]</ref><ref name="pmid8379728">Creswell LL, Schuessler RB, Rosenbloom M, Cox JL (1993) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8379728 Hazards of postoperative atrial arrhythmias.] ''Ann Thorac Surg'' 56 (3):539-49. PMID: [http://pubmed.gov/8379728 8379728]</ref><ref name="pmid1682069">Andrews TC, Reimold SC, Berlin JA, Antman EM (1991) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1682069 Prevention of supraventricular arrhythmias after coronary artery bypass surgery. A meta-analysis of randomized control trials.] ''Circulation'' 84 (5 Suppl):III236-44. PMID: [http://pubmed.gov/1682069 1682069]</ref>  
*The [[incidence]] of [[atrial fibrillation]] after non-[[heart|cardiac]] [[surgery|surgeries]] is between 0.4% and 12%.<ref name="pmid22347631">{{cite journal| author=Chelazzi C, Villa G, De Gaudio AR| title=Postoperative atrial fibrillation. | journal=ISRN Cardiol | year= 2011 | volume= 2011 | issue=  | pages= 203179 | pmid=22347631 | doi=10.5402/2011/203179 | pmc=3262508 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22347631  }} </ref>
*The [[incidence]] of [[atrial fibrillation]] after non-[[heart|cardiac]] [[surgery|surgeries]] is between 0.4% and 12%.<ref name="pmid22347631">{{cite journal| author=Chelazzi C, Villa G, De Gaudio AR| title=Postoperative atrial fibrillation. | journal=ISRN Cardiol | year= 2011 | volume= 2011 | issue=  | pages= 203179 | pmid=22347631 | doi=10.5402/2011/203179 | pmc=3262508 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22347631  }} </ref>
*The following algorithm is a summary of [[surgery|post-operative]] [[atrial fibrillation]] [[pathophysiology]]:<ref name="pmid22347631">{{cite journal| author=Chelazzi C, Villa G, De Gaudio AR| title=Postoperative atrial fibrillation. | journal=ISRN Cardiol | year= 2011 | volume= 2011 | issue=  | pages= 203179 | pmid=22347631 | doi=10.5402/2011/203179 | pmc=3262508 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22347631  }} </ref><ref name="pmid24235971">{{cite journal| author=Vretzakis G, Simeoforidou M, Stamoulis K, Bareka M| title=Supraventricular arrhythmias after thoracotomy: is there a role for autonomic imbalance? | journal=Anesthesiol Res Pract | year= 2013 | volume= 2013 | issue=  | pages= 413985 | pmid=24235971 | doi=10.1155/2013/413985 | pmc=3819881 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24235971  }} </ref><ref name="pmid9277498">{{cite journal| author=Liu L, Nattel S| title=Differing sympathetic and vagal effects on atrial fibrillation in dogs: role of refractoriness heterogeneity. | journal=Am J Physiol | year= 1997 | volume= 273 | issue= 2 Pt 2 | pages= H805-16 | pmid=9277498 | doi=10.1152/ajpheart.1997.273.2.H805 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9277498  }} </ref><ref name="pmid19549643">{{cite journal| author=Jiang Z, Dai JQ, Shi C, Zeng WS, Jiang RC, Tu WF| title=Influence of patient-controlled i.v. analgesia with opioids on supraventricular arrhythmias after pulmonary resection. | journal=Br J Anaesth | year= 2009 | volume= 103 | issue= 3 | pages= 364-8 | pmid=19549643 | doi=10.1093/bja/aep172 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19549643  }} </ref>
<br>
{{familytree/start |summary=Sample 8}}{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree/start}}
{{familytree | | | | | | | | | | | | | | A01 | | |A01=[[pain]] due to [[surgery]]}}
{{familytree | | | | | | B01 |-|-|-|-|-|.|!|,|-| B02 | | | | | | | |B01=[[Hypovolemia]], [[Anemia]], [[Hypoxemia]]|B02=[[Hypothermia]], [[Hypoglycemia]]}}
{{familytree | | | | | | |!| | | | | | | C01 | | | | | | | | | | | |C01=[[Sympathetic nervous system|Sympathetic outflow]] elevation}}
{{familytree | | | | | | |!| | | | | | | |!| | | | | | | | | | | | |}}
{{familytree | | | | | | D01 |-|-|-|-|-| D02 |-|-|-|-|-| D03 | | | |D01=[[Cardiac muscle|Myoardial]] damage|D02=[[Surgery|Post-operative]] [[atrial fibrillation]]|D03=[[Hypokalemia]]}}
{{familytree | | | | | | | | | | E01 |-|'|!|`|-| E02 | | | | | | | |E01=[[Hypervolemia]]|E02=[[Inflammation]] due to [[surgery]]}}
{{familytree | | | | | | | | | | | | | | F01 | | | | | | | | | | | |F01=[[Hypomagnesemia]]}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
{{familytree/end}}
<br>
*[[Atrial fibrillation]] can develop within any time after [[surgery]]. Nevertheless it's [[incidence]] is higher between second and fifth [[surgery|postoperative]] day.<ref name="pmid20575638">{{cite journal| author=Davis EM, Packard KA, Hilleman DE| title=Pharmacologic prophylaxis of postoperative atrial fibrillation in patients undergoing cardiac surgery: beyond beta-blockers. | journal=Pharmacotherapy | year= 2010 | volume= 30 | issue= 7 | pages= 749, 274e-318e | pmid=20575638 | doi=10.1592/phco.30.7.749 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20575638  }} </ref>
*[[Atrial fibrillation]] can develop within any time after [[surgery]]. Nevertheless it's [[incidence]] is higher between second and fifth [[surgery|postoperative]] day.<ref name="pmid20575638">{{cite journal| author=Davis EM, Packard KA, Hilleman DE| title=Pharmacologic prophylaxis of postoperative atrial fibrillation in patients undergoing cardiac surgery: beyond beta-blockers. | journal=Pharmacotherapy | year= 2010 | volume= 30 | issue= 7 | pages= 749, 274e-318e | pmid=20575638 | doi=10.1592/phco.30.7.749 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20575638  }} </ref>
*Predictors of post-[[surgery|operative]] [[AF]] include [[old age|advanced age]], history of [[chronic obstructive pulmonary disease]] ([[COPD]]), [[valvular heart disease]], [[left atrial enlargement]], peri-[[surgery|operative]] [[heart failure]] and discontinuation of either [[beta blocker]] or [[ACEIs|ACE inhibitors]] before or after [[surgery]], and elevated [[surgery|postoperative]] adrenergic tone.<ref name="pmid15082699">Mathew JP, Fontes ML, Tudor IC, Ramsay J, Duke P, Mazer CD et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15082699 A multicenter risk index for atrial fibrillation after cardiac surgery.] ''JAMA'' 291 (14):1720-9. [http://dx.doi.org/10.1001/jama.291.14.1720 DOI:10.1001/jama.291.14.1720] PMID: [http://pubmed.gov/15082699 15082699]</ref> [[pericarditis]] <ref name="pmid3489405">Dixon FE, Genton E, Vacek JL, Moore CB, Landry J (1986) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3489405 Factors predisposing to supraventricular tachyarrhythmias after coronary artery bypass grafting.] ''Am J Cardiol'' 58 (6):476-8. PMID: [http://pubmed.gov/3489405 3489405]</ref>
*The following are some of the general [[risk factors]] of post-[[surgery|operative]] [[atrial fibrillation]]:<ref name="pmid15082699">Mathew JP, Fontes ML, Tudor IC, Ramsay J, Duke P, Mazer CD et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15082699 A multicenter risk index for atrial fibrillation after cardiac surgery.] ''JAMA'' 291 (14):1720-9. [http://dx.doi.org/10.1001/jama.291.14.1720 DOI:10.1001/jama.291.14.1720] PMID: [http://pubmed.gov/15082699 15082699]</ref><ref name="pmid3489405">Dixon FE, Genton E, Vacek JL, Moore CB, Landry J (1986) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3489405 Factors predisposing to supraventricular tachyarrhythmias after coronary artery bypass grafting.] ''Am J Cardiol'' 58 (6):476-8. PMID: [http://pubmed.gov/3489405 3489405]</ref><ref name="pmid8656542">{{cite journal| author=Mathew JP, Parks R, Savino JS, Friedman AS, Koch C, Mangano DT | display-authors=etal| title=Atrial fibrillation following coronary artery bypass graft surgery: predictors, outcomes, and resource utilization. MultiCenter Study of Perioperative Ischemia Research Group. | journal=JAMA | year= 1996 | volume= 276 | issue= 4 | pages= 300-6 | pmid=8656542 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8656542  }} </ref><ref name="pmid16755448">{{cite journal| author=Piechowiak M, Banach M, Ruta J, Barylski M, Rysz J, Bartczak K | display-authors=etal| title=Risk factors for atrial fibrillation in adult patients in long-term observation following surgical closure of atrial septal defect type II. | journal=Thorac Cardiovasc Surg | year= 2006 | volume= 54 | issue= 4 | pages= 259-63 | pmid=16755448 | doi=10.1055/s-2006-923955 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16755448  }} </ref>
**[[old age|Advanced age]]
**[[Male]] [[patients]]
**[[Obesity]]
**[[Pericarditis]]
**History of [[chronic obstructive pulmonary disease]] ([[COPD]])
**[[Valvular heart disease]]
**[[Left atrial enlargement]]
**Peri-[[surgery|operative]] [[heart failure]]
**Discontinuation of either [[beta blocker]] or [[ACEIs|ACE inhibitors]] before or after [[surgery]]
**Elevated [[surgery|postoperative]] adrenergic tone
**[[Chronic renal failure]]
*The following are some of the known [[risk factors]] of [[atrial fibrillation]] development after non-[[heart|cardiac]] [[surgeries]]:<ref name="pmid9670187">{{cite journal| author=Morsi A, Lau C, Nishimura S, Goldman BS| title=The development of sinoatrial dysfunction in pacemaker patients with isolated atrioventricular block. | journal=Pacing Clin Electrophysiol | year= 1998 | volume= 21 | issue= 7 | pages= 1430-4 | pmid=9670187 | doi=10.1111/j.1540-8159.1998.tb00214.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9670187  }} </ref>
**[[Asthma]]
**History of [[valvular heart disease]]
**Specific procedures, such as [[abdominal surgery|abdominal surgeries]] and extensive [[vascular surgery]]
**[[surgery|Intraoperative]] [[hypotension]]
*Paroxysmal form of [[atrial fibrillation]] is common post-[[surgery|operatively]] and is usually self-limiting with [[sinus rhythm]] resuming by 6-8 weeks post-[[surgery]] in more than 90% of [[patients]].<ref name="pmid11270698">Kowey PR, Stebbins D, Igidbashian L, Goldman SM, Sutter FP, Rials SJ et al. (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11270698 Clinical outcome of patients who develop PAF after CABG surgery.] ''Pacing Clin Electrophysiol'' 24 (2):191-3. PMID: [http://pubmed.gov/11270698 11270698]</ref>  
*Paroxysmal form of [[atrial fibrillation]] is common post-[[surgery|operatively]] and is usually self-limiting with [[sinus rhythm]] resuming by 6-8 weeks post-[[surgery]] in more than 90% of [[patients]].<ref name="pmid11270698">Kowey PR, Stebbins D, Igidbashian L, Goldman SM, Sutter FP, Rials SJ et al. (2001) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11270698 Clinical outcome of patients who develop PAF after CABG surgery.] ''Pacing Clin Electrophysiol'' 24 (2):191-3. PMID: [http://pubmed.gov/11270698 11270698]</ref>  
*Although in many cases post-[[surgery|operative]] [[atrial fibrillation]] is self limiting, the following conditions are considered as well known [[Complication (medicine)|complications]] of post-[[surgery|operative]] [[atrial fibrillation]]:<ref name="pmid18294562">{{cite journal| author=Echahidi N, Pibarot P, O'Hara G, Mathieu P| title=Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery. | journal=J Am Coll Cardiol | year= 2008 | volume= 51 | issue= 8 | pages= 793-801 | pmid=18294562 | doi=10.1016/j.jacc.2007.10.043 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18294562  }} </ref><ref name="pmid19174427">{{cite journal| author=Kaireviciute D, Aidietis A, Lip GY| title=Atrial fibrillation following cardiac surgery: clinical features and preventative strategies. | journal=Eur Heart J | year= 2009 | volume= 30 | issue= 4 | pages= 410-25 | pmid=19174427 | doi=10.1093/eurheartj/ehn609 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19174427  }} </ref><ref name="pmid22347631">{{cite journal| author=Chelazzi C, Villa G, De Gaudio AR| title=Postoperative atrial fibrillation. | journal=ISRN Cardiol | year= 2011 | volume= 2011 | issue=  | pages= 203179 | pmid=22347631 | doi=10.5402/2011/203179 | pmc=3262508 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22347631  }} </ref>
**[[Shock]]
**[[Stroke]]
**[[surgery|Perioperative]] [[ST elevation myocardial infarction|myocardial infarction]]
**[[Heart failure]]
**[[Ventricular arrhythmias]]
**Longer period of [[Hospital|hospitalization]]
**Death
*Pre-[[treatment]] with either [[digoxin]] or [[verapamil]] has not shown to prevent [[surgery|postoperative]] [[atrial fibrillation]].<ref name="pmid1682069">Andrews TC, Reimold SC, Berlin JA, Antman EM (1991) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1682069 Prevention of supraventricular arrhythmias after coronary artery bypass surgery. A meta-analysis of randomized control trials.] ''Circulation'' 84 (5 Suppl):III236-44. PMID: [http://pubmed.gov/1682069 1682069]</ref><ref name="pmid1347966">Kowey PR, Taylor JE, Rials SJ, Marinchak RA (1992) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1347966 Meta-analysis of the effectiveness of prophylactic drug therapy in preventing supraventricular arrhythmia early after coronary artery bypass grafting.] ''Am J Cardiol'' 69 (9):963-5. PMID: [http://pubmed.gov/1347966 1347966]</ref><ref name="pmid10440142">Podrid PJ (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10440142 Prevention of postoperative atrial fibrillation: what is the best approach?] ''J Am Coll Cardiol'' 34 (2):340-2. PMID: [http://pubmed.gov/10440142 10440142]</ref>  
*Pre-[[treatment]] with either [[digoxin]] or [[verapamil]] has not shown to prevent [[surgery|postoperative]] [[atrial fibrillation]].<ref name="pmid1682069">Andrews TC, Reimold SC, Berlin JA, Antman EM (1991) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1682069 Prevention of supraventricular arrhythmias after coronary artery bypass surgery. A meta-analysis of randomized control trials.] ''Circulation'' 84 (5 Suppl):III236-44. PMID: [http://pubmed.gov/1682069 1682069]</ref><ref name="pmid1347966">Kowey PR, Taylor JE, Rials SJ, Marinchak RA (1992) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1347966 Meta-analysis of the effectiveness of prophylactic drug therapy in preventing supraventricular arrhythmia early after coronary artery bypass grafting.] ''Am J Cardiol'' 69 (9):963-5. PMID: [http://pubmed.gov/1347966 1347966]</ref><ref name="pmid10440142">Podrid PJ (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10440142 Prevention of postoperative atrial fibrillation: what is the best approach?] ''J Am Coll Cardiol'' 34 (2):340-2. PMID: [http://pubmed.gov/10440142 10440142]</ref>  
*In [[Hemodynamics|hemodynamically]] unstable [[patients]], [[Atrioventricular node|AV nodal]] blocking agents such as [[Beta blocker|short-acting beta-blockers]], [[CCB|nondihydropyridine CCBs]] or [[Intravenous therapy|intravenous]] [[amiodarone]] have been shown to improve [[Hemodynamics|hemodynamics]] in [[patients]] with post-[[surgery|operative]] [[atrial fibrillation]].<ref name="pmid9514456">Clemo HF, Wood MA, Gilligan DM, Ellenbogen KA (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9514456 Intravenous amiodarone for acute heart rate control in the critically ill patient with atrial tachyarrhythmias.] ''Am J Cardiol'' 81 (5):594-8. PMID: [http://pubmed.gov/9514456 9514456]</ref>
*In [[Hemodynamics|hemodynamically]] unstable [[patients]], [[Atrioventricular node|AV nodal]] blocking agents such as [[Beta blocker|short-acting beta-blockers]], [[CCB|nondihydropyridine CCBs]] or [[Intravenous therapy|intravenous]] [[amiodarone]] have been shown to improve [[Hemodynamics|hemodynamics]] in [[patients]] with post-[[surgery|operative]] [[atrial fibrillation]].<ref name="pmid9514456">Clemo HF, Wood MA, Gilligan DM, Ellenbogen KA (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9514456 Intravenous amiodarone for acute heart rate control in the critically ill patient with atrial tachyarrhythmias.] ''Am J Cardiol'' 81 (5):594-8. PMID: [http://pubmed.gov/9514456 9514456]</ref>
*Based on a study, using [[Intravenous therapy|intravenous]] [[analgesics]] in [[patients]] who has pulmonary resection [[surgery]] showed significantly lower rates of [[surgery|postoperative]] [[atrial fibrillation]], compared to the control group.<ref name="pmid19549643">{{cite journal| author=Jiang Z, Dai JQ, Shi C, Zeng WS, Jiang RC, Tu WF| title=Influence of patient-controlled i.v. analgesia with opioids on supraventricular arrhythmias after pulmonary resection. | journal=Br J Anaesth | year= 2009 | volume= 103 | issue= 3 | pages= 364-8 | pmid=19549643 | doi=10.1093/bja/aep172 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19549643  }} </ref>
*Post-[[coronary artery bypass surgery]] ([[CABG]]), there is an increased risk of [[stroke]]; hence, [[heparin]] or [[anticoagulation|oral anticoagulation]] may be appropriate if post-[[surgery|operative]] [[atrial fibrillation]] persists for longer than 48 hours.<ref name="pmid3263571">Reed GL, Singer DE, Picard EH, DeSanctis RW (1988) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3263571 Stroke following coronary-artery bypass surgery. A case-control estimate of the risk from carotid bruits.] ''N Engl J Med'' 319 (19):1246-50. [http://dx.doi.org/10.1056/NEJM198811103191903 DOI:10.1056/NEJM198811103191903] PMID: [http://pubmed.gov/3263571 3263571]</ref><ref name="pmid3661408">Taylor GJ, Malik SA, Colliver JA, Dove JT, Moses HW, Mikell FL et al. (1987) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3661408 Usefulness of atrial fibrillation as a predictor of stroke after isolated coronary artery bypass grafting.] ''Am J Cardiol'' 60 (10):905-7. PMID: [http://pubmed.gov/3661408 3661408]</ref>
*Post-[[coronary artery bypass surgery]] ([[CABG]]), there is an increased risk of [[stroke]]; hence, [[heparin]] or [[anticoagulation|oral anticoagulation]] may be appropriate if post-[[surgery|operative]] [[atrial fibrillation]] persists for longer than 48 hours.<ref name="pmid3263571">Reed GL, Singer DE, Picard EH, DeSanctis RW (1988) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3263571 Stroke following coronary-artery bypass surgery. A case-control estimate of the risk from carotid bruits.] ''N Engl J Med'' 319 (19):1246-50. [http://dx.doi.org/10.1056/NEJM198811103191903 DOI:10.1056/NEJM198811103191903] PMID: [http://pubmed.gov/3263571 3263571]</ref><ref name="pmid3661408">Taylor GJ, Malik SA, Colliver JA, Dove JT, Moses HW, Mikell FL et al. (1987) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3661408 Usefulness of atrial fibrillation as a predictor of stroke after isolated coronary artery bypass grafting.] ''Am J Cardiol'' 60 (10):905-7. PMID: [http://pubmed.gov/3661408 3661408]</ref>


Line 38: Line 78:
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Treating patients who develop [[AF]] after cardiac surgery with a [[beta blocker]] is recommended unless contraindicated. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[treatment|Treating]] [[patients]] who develop [[atrial fibrillation]] after [[heart|cardiac]] [[surgery]] with a [[beta blocker]] is recommended unless [[Contraindication|contraindicated]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' A [[Calcium channel blocker#Non-dihydropyridine|nondihydropyridine calcium antagonist]] is recommended when a [[beta blocker]] is inadequate to achieve rate control in patients with postoperative [[AF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' A [[Calcium channel blocker#Non-dihydropyridine|nondihydropyridine calcium antagonist]] is recommended when a [[beta blocker]] is inadequate to achieve rate control in [[patients]] with [[surgery|postoperative]] [[atrial fibrillation]].''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}
|}


Line 47: Line 87:
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Preoperative administration of amiodarone reduces the incidence of [[AF]] in patients undergoing cardiac surgery and is reasonable as prophylactic therapy for patients at high risk for postoperative [[AF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' [[surgery|Preoperative]] administration of [[amiodarone]] reduces the [[incidence]] of [[atrial fibrillation]] in [[patients]] undergoing [[heart|cardiac]] [[surgery]] and is reasonable as [[Prophylaxis|prophylactic]] [[therapy]] for [[patients]] at high risk for [[surgery|postoperative]] [[atrial fibrillation]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
|-
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' It is reasonable to restore [[sinus rhythm]] pharmacologically with ibutilide or direct-current [[cardioversion]] in patients who develop postoperative [[AF]], as advised for nonsurgical patients. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' It is reasonable to restore [[sinus rhythm]] pharmacologically with [[ibutilide]] or direct-current [[cardioversion]] in [[patients]] who develop postoperative [[atrial fibrillation]], as advised for [[surgery|nonsurgical]] [[patients]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' It is reasonable to administer [[antiarrhythmic|antiarrhythmic medications]] in an attempt to maintain [[sinus rhythm]] in patients with recurrent or refractory postoperative [[AF]], as advised for other patients who develop [[AF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' It is reasonable to administer [[antiarrhythmic|antiarrhythmic medications]] in an attempt to maintain [[sinus rhythm]] in [[patients]] with recurrent or refractory [[surgery|postoperative]] [[atrial fibrillation]], as advised for other [[patients]] who develop [[atrial fibrillation]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' It is reasonable to administer [[antithrombotic]] medication in patients who develop postoperative [[AF]], as advised for nonsurgical patients. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' It is reasonable to administer [[antithrombotic]] [[medication]] in [[patients]] who develop [[surgery|postoperative]] [[atrial fibrillation]], as advised for [[surgery|nonsurgical]] [[patients]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''5.''' It is reasonable to manage well-tolerated, new-onset postoperative [[AF]] with rate control and anticoagulation with cardioversion if [[AF]] does not revert spontaneously to sinus rhythm during follow-up. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''5.''' It is reasonable to manage well-tolerated, new-onset [[surgery|postoperative]] [[atrial fibrillation]] with rate control and [[Anticoagulant|anticoagulation]] with [[cardioversion]] if [[atrial fibrillation]] does not revert spontaneously to [[sinus rhythm]] during follow-up. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
|}


Line 62: Line 102:
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Prophylactic administration of [[sotalol]] may be considered for patients at risk of developing [[AF]] following cardiac surgery. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Prophylactic administration of [[sotalol]] may be considered for [[patients]] at risk of developing [[atrial fibrillation]] following [[heart|cardiac]] [[surgery]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Administration of [[colchicine]] may be considered for patients postoperatively to reduce [[AF]] following cardiac surgery. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Administration of [[colchicine]] may be considered for [[patients]] [[surgery|postoperatively]] to reduce [[atrial fibrillation]] following [[heart|cardiac]] [[surgery]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}
|}


Line 74: Line 114:
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Unless contraindicated, treatment with an oral [[beta blocker]] to prevent postoperative [[AF]] is recommended for patients undergoing [[cardiac surgery]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Unless [[Contraindication|contraindicated]], [[treatment]] with an [[mouth|oral]] [[beta blocker]] to prevent [[surgery|postoperative]] [[atrial fibrillation]] is recommended for [[patients]] undergoing [[cardiac surgery]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Administration of AV nodal blocking agents is recommended to achieve rate control in patients who develop postoperative [[AF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Administration of [[Atrioventricular node|AV nodal]] blocking agents is recommended to achieve rate control in [[patients]] who develop postoperative [[atrial fibrillation]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}
|}


Line 83: Line 123:
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''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]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' [[surgery|Preoperative]] administration of [[amiodarone]] reduces the [[incidence]] of [[atrial fibrillation]] in [[patients]] undergoing [[cardiac surgery]] and represents appropriate [[Prophylaxis|prophylactic]] [[therapy]] for [[patients]] at high risk for [[surgery|postoperative]] [[atrial fibrillation]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
|-
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''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. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' It is reasonable to restore [[sinus rhythm]] by [[pharmcology|pharmacological]] [[cardioversion]] with [[ibutilide]] or [[direct current cardioversion]] in [[patients]] who develop [[surgery|postoperative]] [[atrial fibrillation]] as advised for [[surgery|nonsurgical]] [[patients]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''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]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' It is reasonable to administer [[antiarrhythmic medications]] in an attempt to maintain [[sinus rhythm]] in [[patients]] with recurrent or refractory [[surgery|postoperative]] [[atrial fibrillation]], as recommended for other [[patients]] who develop [[atrial fibrillation]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' It is reasonable to administer [[antithrombotic medication]] in patients who develop postoperative [[AF]], as recommended for nonsurgical patients. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' It is reasonable to administer [[antithrombotic medication]] in [[patients]] who develop [[surgery|postoperative]] [[atrial fibrillation]], as recommended for nonsurgical patients. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}
|}


Line 96: Line 136:
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''  Prophylactic administration of [[sotalol]] may be considered for patients at risk of developing [[AF]] following [[cardiac surgery]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''  [[Prophylaxis|Prophylactic]] administration of [[sotalol]] may be considered for [[patients]] at risk of developing [[atrial fibrillation]] following [[cardiac surgery]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}
|}


Latest revision as of 04:39, 3 September 2021
Resident
Survival
Guide
File:Critical Pathways.gif

Sinus rhythm
Atrial fibrillation

Atrial Fibrillation Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Atrial Fibrillation from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Special Groups

Postoperative AF
Acute Myocardial Infarction
Wolff-Parkinson-White Preexcitation Syndrome
Hypertrophic Cardiomyopathy
Hyperthyroidism
Pulmonary Diseases
Pregnancy
ACS and/or PCI or valve intervention
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Diagnosis

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Physical Examination

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A-Fib with LBBB

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Treatment

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Cardioversion

Overview
Electrical Cardioversion
Pharmacological Cardioversion

Anticoagulation

Overview
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Converting from or to Warfarin
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Dabigatran

Maintenance of Sinus Rhythm

Surgery

Catheter Ablation
AV Nodal Ablation
Surgical Ablation
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Cost-Effectiveness of Therapy

Case Studies

Case #1

Postoperative atrial fibrillation On the Web

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Powerpoint slides

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US National Guidelines Clearinghouse

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Risk calculators and risk factors for Postoperative atrial fibrillation

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2] Cafer Zorkun, M.D., Ph.D. [3]; Varun Kumar, M.B.B.S.

Overview

Post-operative atrial fibrillation is common in cardiac or non-cardiac surgeries. The incidence of atrial fibrillation in post-coronary artery bypass surgery (CABG) and non-cardiac surgery patients are 20%-50% and 0.4%-12%, respectively. pain and inflammation due to surgery, hypovolemia and hypervolemia, anemia, hypoxemia, hypomagnesemia and hypokalemia are some of the known factors in pathogenesis of atrial fibrillation after surgery. Although atrial fibrillation can develop within any time after surgery, it's incidence is higher between second and fifth postoperative day. Advanced age, male gender, obesity, history of chronic obstructive pulmonary disease, valvular heart disease and chronic renal failure are some of the risk factors of post operative atrial fibrillation. To address post operative atrial fibrillation there are both pharmacological and non-pharmacological treatments. In hemodynamically unstable patients, AV nodal blocking agents such as short-acting beta-blockers, nondihydropyridine CCBs or intravenous amiodarone have been shown to improve hemodynamics in patients with post-operative atrial fibrillation. Based on a study, using intravenous analgesics in patients who has pulmonary resection surgery showed significantly lower rates of postoperative atrial fibrillation, compared to the control group.

Postoperative Atrial fibrillation


 
 
 
 
 
 
 
 
 
 
 
 
 
pain due to surgery
 
 
 
 
 
 
 
Hypovolemia, Anemia, Hypoxemia
 
 
 
 
 
 
 
 
 
 
 
 
Hypothermia, Hypoglycemia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Sympathetic outflow elevation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Myoardial damage
 
 
 
 
 
Post-operative atrial fibrillation
 
 
 
 
 
Hypokalemia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hypervolemia
 
 
 
 
 
 
 
 
Inflammation due to surgery
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hypomagnesemia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)[22]

Postoperative Cardiac and Thoracic Surgery

Class I
"1. Treating patients who develop atrial fibrillation after cardiac surgery with a beta blocker is recommended unless contraindicated. (Level of Evidence: A)"
"2. A nondihydropyridine calcium antagonist is recommended when a beta blocker is inadequate to achieve rate control in patients with postoperative atrial fibrillation.(Level of Evidence: B)"
Class IIa
"1. Preoperative administration of amiodarone reduces the incidence of atrial fibrillation in patients undergoing cardiac surgery and is reasonable as prophylactic therapy for patients at high risk for postoperative atrial fibrillation. (Level of Evidence: A)"
"2. It is reasonable to restore sinus rhythm pharmacologically with ibutilide or direct-current cardioversion in patients who develop postoperative atrial fibrillation, 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 atrial fibrillation, as advised for other patients who develop atrial fibrillation. (Level of Evidence: B)"
"4. It is reasonable to administer antithrombotic medication in patients who develop postoperative atrial fibrillation, as advised for nonsurgical patients. (Level of Evidence: B)"
"5. It is reasonable to manage well-tolerated, new-onset postoperative atrial fibrillation with rate control and anticoagulation with cardioversion if atrial fibrillation does not revert spontaneously to sinus rhythm during follow-up. (Level of Evidence: C)"
Class IIb
"1. Prophylactic administration of sotalol may be considered for patients at risk of developing atrial fibrillation following cardiac surgery. (Level of Evidence: B)"
"2. Administration of colchicine may be considered for patients postoperatively to reduce atrial fibrillation following cardiac surgery. (Level of Evidence: B)"

2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)[23][24]

Postoperative AF (DO NOT EDIT)[23][24]

Class I
"1. Unless contraindicated, treatment with an oral beta blocker to prevent postoperative atrial fibrillation 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 atrial fibrillation. (Level of Evidence: B)"
Class IIa
"1. Preoperative administration of amiodarone reduces the incidence of atrial fibrillation in patients undergoing cardiac surgery and represents appropriate prophylactic therapy for patients at high risk for postoperative atrial fibrillation. (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 atrial fibrillation 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 atrial fibrillation, as recommended for other patients who develop atrial fibrillation. (Level of Evidence: B)"
"4. It is reasonable to administer antithrombotic medication in patients who develop postoperative atrial fibrillation, 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 atrial fibrillation following cardiac surgery. (Level of Evidence: B)"

References

  1. ↑ 1.0 1.1 1.2 1.3 Chelazzi C, Villa G, De Gaudio AR (2011). "Postoperative atrial fibrillation". ISRN Cardiol. 2011: 203179. doi:10.5402/2011/203179. PMC 3262508. PMID 22347631.
  2. ↑ Soria R, Guize L, Chretien JM, Le Heuzey JY, Lavergne T, Desnos M et al. (1989) [The natural history of 270 cases of Wolff-Parkinson-White syndrome in a survey of the general population.] Arch Mal Coeur Vaiss 82 (3):331-6. PMID: 2502088
  3. ↑ Creswell LL, Schuessler RB, Rosenbloom M, Cox JL (1993) Hazards of postoperative atrial arrhythmias. Ann Thorac Surg 56 (3):539-49. PMID: 8379728
  4. ↑ 4.0 4.1 Andrews TC, Reimold SC, Berlin JA, Antman EM (1991) Prevention of supraventricular arrhythmias after coronary artery bypass surgery. A meta-analysis of randomized control trials. Circulation 84 (5 Suppl):III236-44. PMID: 1682069
  5. ↑ Vretzakis G, Simeoforidou M, Stamoulis K, Bareka M (2013). "Supraventricular arrhythmias after thoracotomy: is there a role for autonomic imbalance?". Anesthesiol Res Pract. 2013: 413985. doi:10.1155/2013/413985. PMC 3819881. PMID 24235971.
  6. ↑ Liu L, Nattel S (1997). "Differing sympathetic and vagal effects on atrial fibrillation in dogs: role of refractoriness heterogeneity". Am J Physiol. 273 (2 Pt 2): H805–16. doi:10.1152/ajpheart.1997.273.2.H805. PMID 9277498.
  7. ↑ 7.0 7.1 Jiang Z, Dai JQ, Shi C, Zeng WS, Jiang RC, Tu WF (2009). "Influence of patient-controlled i.v. analgesia with opioids on supraventricular arrhythmias after pulmonary resection". Br J Anaesth. 103 (3): 364–8. doi:10.1093/bja/aep172. PMID 19549643.
  8. ↑ Davis EM, Packard KA, Hilleman DE (2010). "Pharmacologic prophylaxis of postoperative atrial fibrillation in patients undergoing cardiac surgery: beyond beta-blockers". Pharmacotherapy. 30 (7): 749, 274e–318e. doi:10.1592/phco.30.7.749. PMID 20575638.
  9. ↑ Mathew JP, Fontes ML, Tudor IC, Ramsay J, Duke P, Mazer CD et al. (2004) A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA 291 (14):1720-9. DOI:10.1001/jama.291.14.1720 PMID: 15082699
  10. ↑ Dixon FE, Genton E, Vacek JL, Moore CB, Landry J (1986) Factors predisposing to supraventricular tachyarrhythmias after coronary artery bypass grafting. Am J Cardiol 58 (6):476-8. PMID: 3489405
  11. ↑ Mathew JP, Parks R, Savino JS, Friedman AS, Koch C, Mangano DT; et al. (1996). "Atrial fibrillation following coronary artery bypass graft surgery: predictors, outcomes, and resource utilization. MultiCenter Study of Perioperative Ischemia Research Group". JAMA. 276 (4): 300–6. PMID 8656542.
  12. ↑ Piechowiak M, Banach M, Ruta J, Barylski M, Rysz J, Bartczak K; et al. (2006). "Risk factors for atrial fibrillation in adult patients in long-term observation following surgical closure of atrial septal defect type II". Thorac Cardiovasc Surg. 54 (4): 259–63. doi:10.1055/s-2006-923955. PMID 16755448.
  13. ↑ Morsi A, Lau C, Nishimura S, Goldman BS (1998). "The development of sinoatrial dysfunction in pacemaker patients with isolated atrioventricular block". Pacing Clin Electrophysiol. 21 (7): 1430–4. doi:10.1111/j.1540-8159.1998.tb00214.x. PMID 9670187.
  14. ↑ Kowey PR, Stebbins D, Igidbashian L, Goldman SM, Sutter FP, Rials SJ et al. (2001) Clinical outcome of patients who develop PAF after CABG surgery. Pacing Clin Electrophysiol 24 (2):191-3. PMID: 11270698
  15. ↑ Echahidi N, Pibarot P, O'Hara G, Mathieu P (2008). "Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery". J Am Coll Cardiol. 51 (8): 793–801. doi:10.1016/j.jacc.2007.10.043. PMID 18294562.
  16. ↑ Kaireviciute D, Aidietis A, Lip GY (2009). "Atrial fibrillation following cardiac surgery: clinical features and preventative strategies". Eur Heart J. 30 (4): 410–25. doi:10.1093/eurheartj/ehn609. PMID 19174427.
  17. ↑ Kowey PR, Taylor JE, Rials SJ, Marinchak RA (1992) Meta-analysis of the effectiveness of prophylactic drug therapy in preventing supraventricular arrhythmia early after coronary artery bypass grafting. Am J Cardiol 69 (9):963-5. PMID: 1347966
  18. ↑ Podrid PJ (1999) Prevention of postoperative atrial fibrillation: what is the best approach? J Am Coll Cardiol 34 (2):340-2. PMID: 10440142
  19. ↑ Clemo HF, Wood MA, Gilligan DM, Ellenbogen KA (1998) Intravenous amiodarone for acute heart rate control in the critically ill patient with atrial tachyarrhythmias. Am J Cardiol 81 (5):594-8. PMID: 9514456
  20. ↑ Reed GL, Singer DE, Picard EH, DeSanctis RW (1988) Stroke following coronary-artery bypass surgery. A case-control estimate of the risk from carotid bruits. N Engl J Med 319 (19):1246-50. DOI:10.1056/NEJM198811103191903 PMID: 3263571
  21. ↑ Taylor GJ, Malik SA, Colliver JA, Dove JT, Moses HW, Mikell FL et al. (1987) Usefulness of atrial fibrillation as a predictor of stroke after isolated coronary artery bypass grafting. Am J Cardiol 60 (10):905-7. PMID: 3661408
  22. ↑ January, C. T.; Wann, L. S.; Alpert, J. S.; Calkins, H.; Cleveland, J. C.; Cigarroa, J. E.; Conti, J. B.; Ellinor, P. T.; Ezekowitz, M. D.; Field, M. E.; Murray, K. T.; Sacco, R. L.; Stevenson, W. G.; Tchou, P. J.; Tracy, C. M.; Yancy, C. W. (2014). "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society". Circulation. doi:10.1161/CIR.0000000000000041. ISSN 0009-7322.
  23. ↑ 23.0 23.1 Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA; et al. (2011). "2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society". J Am Coll Cardiol. 57 (11): e101–98. doi:10.1016/j.jacc.2010.09.013. PMID 21392637.
  24. ↑ 24.0 24.1 Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114 (7):e257-354. DOI:10.1161/CIRCULATIONAHA.106.177292 PMID: 16908781


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