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*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>
*[[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 known [[risk factors]] of post-[[surgery|operative]] [[AF]]:<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><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]]
**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]]
*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>  
*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>  

Revision as of 20:07, 1 September 2021
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Sinus rhythm
Atrial fibrillation

Atrial Fibrillation Microchapters

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

Overview

Postoperative Atrial fibrillation

2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)[16]

Postoperative Cardiac and Thoracic Surgery

Class I
"1. Treating patients who develop AF 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 AF. (Level of Evidence: B)"
Class IIa
"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. (Level of Evidence: A)"
"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. (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 advised 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 advised for nonsurgical patients. (Level of Evidence: B)"
"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. (Level of Evidence: C)"
Class IIb
"1. Prophylactic administration of sotalol may be considered for patients at risk of developing AF following cardiac surgery. (Level of Evidence: B)"
"2. Administration of colchicine may be considered for patients postoperatively to reduce AF 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)[17][18]

Postoperative AF (DO NOT EDIT)[17][18]

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)"

References

  1. ↑ 1.0 1.1 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. ↑ 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.
  6. ↑ 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
  7. ↑ 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
  8. ↑ 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.
  9. ↑ 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.
  10. ↑ 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
  11. ↑ 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
  12. ↑ Podrid PJ (1999) Prevention of postoperative atrial fibrillation: what is the best approach? J Am Coll Cardiol 34 (2):340-2. PMID: 10440142
  13. ↑ 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
  14. ↑ 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
  15. ↑ 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
  16. ↑ 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.
  17. ↑ 17.0 17.1 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.
  18. ↑ 18.0 18.1 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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