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====7.5 | ====7.5 Hyperthyroidism==== | ||
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Revision as of 23:05, 31 March 2014
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Atrial Fibrillation Microchapters | |
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Special Groups | |
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Diagnosis | |
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Treatment | |
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Cardioversion | |
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Anticoagulation | |
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Surgery | |
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Case Studies | |
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Sandbox AF2014 On the Web | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)[1]
AF Classification
- Based on the duration of atrial fibrillation (AF) episodes, AHA/ACC/HRS published a simplified classification scheme given in the table below:
- Lone AF is a historical term which refers to atrial fibrillation in younger individuals (<60 years of age) without clinical or echocardiographic evidence of cardiopulmonary disease, hypertension, or diabetes mellitus. Because of its variable definitions, the term is potentially confusing and should not be used to guide therapeutic decisions.[1]
| Term | Definition |
|---|---|
| Paroxysmal AF |
|
| Persistent AF |
|
| Longstanding Persistent AF |
|
| Permanent AF |
|
| Nonvalvular AF |
|
3. Clinical Evaluation
| Class I |
| "1. Electrocardiographic documentation is recommended to establish the diagnosis of AF. (Level of Evidence: C) " |
4. Prevention of Thromboembolism
4.1 Risk-Based Antithrombotic Therapy
| Class I |
| "1. In patients with AF, antithrombotic therapy should be individualized based on shared decision-making after discussion of the absolute and RRs of stroke and bleeding, and the patient’s values and preferences. (Level of Evidence: C) " |
| "2. Selection of antithrombotic therapy should be based on the risk of thromboembolism irrespective of whether the AF pattern is paroxysmal, persistent, or permanent. (Level of Evidence: B) " |
| "3. In patients with nonvalvular AF, the CHA2DS2-VASc score is recommended for assessment of stroke risk. (Level of Evidence: B) " |
| "4. For patients with AF who have mechanical heart valves, warfarin is recommended and the target international normalized ratio (INR) intensity (2.0 to 3.0 or 2.5 to 3.5) should be based on the type and location of the prosthesis. (Level of Evidence: B) " |
| "5. For patients with nonvalvular AF with prior stroke, transient ischemic attack (TIA), or a CHA2DS2-VASc score of 2 or greater, oral anticoagulants are recommended. Options include: warfarin (INR 2.0 to 3.0) (Level of Evidence: A), dabigatran (Level of Evidence: B), rivaroxaban (Level of Evidence: B), or apixaban (Level of Evidence: B)." |
| "6. Among patients treated with warfarin, the INR should be determined at least weekly during initiation of antithrombotic therapy and at least monthly when anticoagulation (INR in range) is stable. (Level of Evidence: A) " |
| "7. For patients with nonvalvular AF unable to maintain a therapeutic INR level with warfarin, use of a direct thrombin or factor Xa inhibitor (dabigatran, rivaroxaban, or apixaban) is recommended. (Level of Evidence: C) " |
| "8. Re-evaluation of the need for and choice of antithrombotic therapy at periodic intervals is recommended to reassess stroke and bleeding risks. (Level of Evidence: C) " |
| "9. Bridging therapy with unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) is recommended for patients with AF and a mechanical heart valve undergoing procedures that require interruption of warfarin. Decisions regarding bridging therapy should balance the risks of stroke and bleeding. (Level of Evidence: C) " |
| "10. For patients with AF without mechanical heart valves who require interruption of warfarin or newer anticoagulants for procedures, decisions about bridging therapy (LMWH or UFH) should balance the risks of stroke and bleeding and the duration of time a patient will not be anticoagulated. (Level of Evidence: C) " |
| "11. Renal function should be evaluated prior to initiation of direct thrombin or factor Xa inhibitors and should be re-evaluated when clinically indicated and at least annually. (Level of Evidence: B) " |
| "12. For patients with atrial flutter, antithrombotic therapy is recommended according to the same risk profile used for AF. (Level of Evidence: C) " |
| Class III: No Benefit |
| "1. The direct thrombin inhibitor, dabigatran, and the factor Xa inhibitor, rivaroxaban, are not recommended in patients with AF and end-stage CKD or on hemodialysis because of the lack of evidence from clinical trials regarding the balance of risks and benefits. (Level of Evidence: C) " |
| Class III: Harm |
| "1. The direct thrombin inhibitor, dabigatran, should not be used in patients with AF and a mechanical heart valve. (Level of Evidence: B) " |
| Class IIa |
| "1. For patients with nonvalvular AF and a CHA2DS2-VASc score of 0, it is reasonable to omit antithrombotic therapy. (Level of Evidence: B) " |
| "2. For patients with nonvalvular AF with a CHA2DS2-VASc score of 2 or greater and who have end-stage CKD (creatinine clearance [CrCl] <15 mL/min) or are on hemodialysis, it is reasonable to prescribe warfarin (INR 2.0 to 3.0) for oral anticoagulation. (Level of Evidence: B) " |
| Class IIb |
| "1. For patients with nonvalvular AF and a CHA2DS2-VASc score of 1, no antithrombotic therapy or treatment with an oral anticoagulant or aspirin may be considered. (Level of Evidence: C) " |
| "2. For patients with nonvalvular AF and moderate-to-severe CKD with CHA2DS2-VASc scores of 2 or greater, treatment with reduced doses of direct thrombin or factor Xa inhibitors may be considered (e.g., dabigatran, rivaroxaban, or apixaban), but safety and efficacy have not been established. (Level of Evidence: C) " |
| "3. In patients with AF undergoing percutaneous coronary intervention, bare-metal stents may be considered to minimize the required duration of dual antiplatelet therapy. Anticoagulation may be interrupted at the time of the procedure to reduce the risk of bleeding at the site of peripheral arterial puncture. (Level of Evidence: C) " |
| "4. Following coronary revascularization (percutaneous or surgical) in patients with AF and a CHA2DS2-VASc score of 2 or greater, it may be reasonable to use clopidogrel (75 mg once daily) concurrently with oral anticoagulants but without aspirin. (Level of Evidence: B) " |
4.4.2 Cardiac Surgery—LAA Occlusion/Excision
| Class IIb |
| "1. Surgical excision of the left atrial appendage (LAA) may be considered in patients undergoing cardiac surgery. (Level of Evidence: C) " |
5. Rate Control
| Class I |
| "1. Control of the ventricular rate using a beta blocker or nondihydropyridine calcium channel antagonist is recommended for patients with paroxysmal, persistent, or permanent AF. (Level of Evidence: B) " |
| "2. Intravenous administration of a beta blocker or nondihydropyridine calcium channel blocker is recommended to slow the ventricular heart rate in the acute setting in patients without pre-excitation. In hemodynamically unstable patients, electrical cardioversion is indicated. (Level of Evidence: B) " |
| "3. In patients who experience AF-related symptoms during activity, the adequacy of heart rate control should be assessed during exertion, adjusting pharmacological treatment as necessary to keep the ventricular rate within the physiological range. (Level of Evidence: C) " |
| Class III: Harm |
| "1. AV nodal ablation with permanent ventricular pacing should not be performed to improve rate control without prior attempts to achieve rate control with medications. (Level of Evidence: C)" |
| "2. Nondihydropyridine calcium channel antagonists should not be used in patients with decompensated HF as these may lead to further hemodynamic compromise. (Level of Evidence: C)" |
| "3. In patients with pre-excitation and AF, digoxin, nondihydropyridine calcium channel antagonists, or intravenous amiodarone should not be administered as they may increase the ventricular response and may result in ventricular fibrillation. (Level of Evidence: B)" |
| "4. Dronedarone should not be used to control the ventricular rate in patients with permanent AF as it increases the risk of the combined endpoint of stroke, MI, systemic embolism, or cardiovascular death. (Level of Evidence: B)" |
| Class IIa |
| "1. A heart rate control (resting heart rate <80 bpm) strategy is reasonable for symptomatic management of AF. (Level of Evidence: B)" |
| "2. Intravenous amiodarone can be useful for rate control in critically ill patients without pre-excitation. (Level of Evidence: B)" |
| "3. AV nodal ablation with permanent ventricular pacing is reasonable to control the heart rate when pharmacological therapy is inadequate and rhythm control is not achievable. (Level of Evidence: B)" |
| Class IIb |
| "1. A lenient rate-control strategy (resting heart rate <110 bpm) may be reasonable as long as patients remain asymptomatic and LV systolic function is preserved. (Level of Evidence: B)" |
| "2. Oral amiodarone may be useful for ventricular rate control when other measures are unsuccessful or contraindicated. (Level of Evidence: C)" |
6. Rhythm Control
6.1 Electrical and Pharmacological Cardioversion of AF and Atrial Flutter
6.1.1 Thromboembolism Prevention
| Class I |
| "1. For patients with AF or atrial flutter of 48-hour duration or longer, or when the duration of AF is unknown, anticoagulation with warfarin (INR 2.0 to 3.0) is recommended for at least 3 weeks prior to and 4 weeks after cardioversion, regardless of the CHA2DS2-VASc score and the method (electrical or pharmacological) used to restore sinus rhythm. (Level of Evidence: B)" |
| "2. For patients with AF or atrial flutter of more than 48 hours or unknown duration that requires immediate cardioversion for hemodynamic instability, anticoagulation should be initiated as soon as possible and continued for at least 4 weeks after cardioversion unless contraindicated. (Level of Evidence: C)" |
| "3. For patients with AF or atrial flutter of less than 48-hour duration and with high risk of stroke, intravenous heparin or LMWH, or administration of a factor Xa or direct thrombin inhibitor, is recommended as soon as possible before or immediately after cardioversion, followed by long-term anticoagulation therapy. (Level of Evidence: C)" |
| "4. Following cardioversion for AF of any duration, the decision regarding long-term anticoagulation therapy should be based on the thromboembolic risk profile. (Level of Evidence: C)" |
| Class IIa |
| "1. For patients with AF or atrial flutter of 48-hour duration or longer or of unknown duration who have not been anticoagulated for the preceding 3 weeks, it is reasonable to perform a TEE prior to cardioversion and proceed with cardioversion if no LA thrombus is identified, including in the LAA, provided that anticoagulation is achieved before TEE and maintained after cardioversion for at least 4 weeks. (Level of Evidence: B)" |
| "2. For patients with AF or atrial flutter of 48-hour duration or longer, or when the duration of AF is unknown, anticoagulation with dabigatran, rivaroxaban, or apixaban is reasonable for at least 3 weeks prior to and 4 weeks after cardioversion. (Level of Evidence: C)" |
| Class IIb |
| "1. For patients with AF or atrial flutter of less than 48-hour duration who are at low thromboembolic risk, anticoagulation (intravenous heparin, LMWH, or a new oral anticoagulant) or no antithrombotic therapy may be considered for cardioversion, without the need for postcardioversion oral anticoagulation. (Level of Evidence: C)" |
6.1.2 Direct-Current Cardioversion
| Class I |
| "1. In pursuing a rhythm-control strategy, cardioversion is recommended for patients with AF or atrial flutter as a method to restore sinus rhythm. If cardioversion is unsuccessful, repeated direct-current cardioversion attempts may be made after adjusting the location of the electrodes or applying pressure over the electrodes, or following administration of an antiarrhythmic medication. (Level of Evidence: B)" |
| "2. Cardioversion is recommended when a rapid ventricular response to AF or atrial flutter does not respond promptly to pharmacological therapies and contributes to ongoing myocardial ischemia, hypotension, or HF. (Level of Evidence: C)" |
| "3. Cardioversion is recommended for patients with AF or atrial flutter and pre-excitation when tachycardia is associated with hemodynamic instability. (Level of Evidence: C)" |
| Class IIa |
| "1. It is reasonable to perform repeated cardioversions in patients with persistent AF provided that sinus rhythm can be maintained for a clinically meaningful period between cardioversion procedures. Severity of AF symptoms and patient preference should be considered when embarking on a strategy requiring serial cardioversion procedures. (Level of Evidence: C)" |
6.1.3 Pharmacological Cardioversion
| Class I |
| "1. Flecainide, dofetilide, propafenone, and intravenous ibutilide are useful for pharmacological cardioversion of AF or atrial flutter provided contraindications to the selected drug are absent. (Level of Evidence: A) " |
| Class III: Harm |
| "1. Dofetilide therapy should not be initiated out of hospital owing to the risk of excessive QT prolongation that can cause torsades de pointes. (Level of Evidence: B) " |
| Class IIa |
| "1. Administration of oral amiodarone is a reasonable option for pharmacological cardioversion of AF. (Level of Evidence: A) " |
| "2. Propafenone or flecainide (“pill-in-the-pocket”) in addition to a beta blocker or nondihydropyridine calcium channel antagonist is reasonable to terminate AF outside the hospital once this treatment has been observed to be safe in a monitored setting for selected patients. (Level of Evidence: B) " |
6.2 Pharmacological Agents for Preventing AF and Maintaining Sinus Rhythm
6.2.1 Antiarrhythmic Drugs to Maintain Sinus Rhythm
| Class I |
| "1. Before initiating antiarrhythmic drug therapy, treatment of precipitating or reversible causes of AF is recommended. (Level of Evidence: C)" |
| "2. The following antiarrhythmic drugs are recommended in patients with AF to maintain sinus rhythm, depending on underlying heart disease and comorbidities: a. Amiodarone, b. Dofetilide, c. Dronedarone, d. Flecainide, e. Propafenone, f. Sotalol. (Level of Evidence: A)" |
| "3. The risks of the antiarrhythmic drug, including proarrhythmia, should be considered before initiating therapy with each drug. (Level of Evidence: C)" |
| "4. Owing to its potential toxicities, amiodarone should only be used after consideration of risks and when other agents have failed or are contraindicated. (Level of Evidence: C)" |
| Class III: Harm |
| "1. Antiarrhythmic drugs for rhythm control should not be continued when AF becomes permanent (Level of Evidence: C) including dronedarone. (Level of Evidence: B)" |
| "2. Dronedarone should not be used for treatment of AF in patients with New York Heart Association (NYHA) class III and IV HF or patients who have had an episode of decompensated HF in the past 4 weeks. (Level of Evidence: B)" |
| Class IIa |
| "1. A rhythm-control strategy with pharmacological therapy can be useful in patients with AF for the treatment of tachycardia-induced cardiomyopathy. (Level of Evidence: C)" |
| Class IIb |
| "1. It may be reasonable to continue current antiarrhythmic drug therapy in the setting of infrequent, well-tolerated recurrences of AF, when the drug has reduced the frequency or symptoms of AF. (Level of Evidence: C)" |
6.2.2. Upstream Therapy
| Class III: No Benefit |
| "1. Therapy with an ACE inhibitor, ARB, or statin is not beneficial for primary prevention of AF in patients without cardiovascular disease. (Level of Evidence: B)" |
| Class IIa |
| "1. An ACE inhibitor or angiotensin-receptor blocker (ARB) is reasonable for primary prevention of new-onset AF in patients with HF with reduced LVEF. (Level of Evidence: B)" |
| Class IIb |
| "1. Therapy with an ACE inhibitor or ARB may be considered for primary prevention of new-onset AF in the setting of hypertension. (Level of Evidence: B)" |
| "2. Statin therapy may be reasonable for primary prevention of new-onset AF after coronary artery surgery. (Level of Evidence: A)" |
6.3 AF Catheter Ablation to Maintain Sinus Rhythm
| Class I |
| "1. AF catheter ablation is useful for symptomatic paroxysmal AF refractory or intolerant to at least 1 class I or III antiarrhythmic medication when a rhythm control strategy is desired. (Level of Evidence: A)" |
| "2. Prior to consideration of AF catheter ablation, assessment of the procedural risks and outcomes relevant to the individual patient is recommended. (Level of Evidence: C)" |
| Class III: Harm |
| "1. AF catheter ablation should not be performed in patients who cannot be treated with anticoagulant therapy during and following the procedure. (Level of Evidence: C)" |
| "2. AF catheter ablation to restore sinus rhythm should not be performed with the sole intent of obviating the need for anticoagulation. (Level of Evidence: C)" |
| Class IIa |
| "1. AF catheter ablation is reasonable for selected patients with symptomatic persistent AF refractory or intolerant to at least 1 class I or III antiarrhythmic medication. (Level of Evidence: A)" |
| "2. In patients with recurrent symptomatic paroxysmal AF, catheter ablation is a reasonable initial rhythm control strategy prior to therapeutic trials of antiarrhythmic drug therapy, after weighing risks and outcomes of drug and ablation therapy. (Level of Evidence: B)" |
| Class IIb |
| "1. AF catheter ablation may be considered for symptomatic long-standing (>12 months) persistent AF refractory or intolerant to at least 1 class I or III antiarrhythmic medication, when a rhythm control strategy is desired. (Level of Evidence: B)" |
| "2. AF catheter ablation may be considered prior to initiation of antiarrhythmic drug therapy with a class I or III antiarrhythmic medication for symptomatic persistent AF, when a rhythm control strategy is desired. (Level of Evidence: C)" |
6.5 Surgery Maze Procedures
| Class IIa |
| "1. An AF surgical ablation procedure is reasonable for selected patients with AF undergoing cardiac surgery for other indications. (Level of Evidence: C)" |
| Class IIb |
| "1. A stand-alone AF surgical ablation procedure may be reasonable for selected patients with highly symptomatic AF not well managed with other approaches. (Level of Evidence: B)" |
7. Specific Patient Groups and AF
7.3 Hypertrophic Cardiomyopathy
| Class I |
| "1. Anticoagulation is indicated in patients with HCM with AF independent of the CHA2DS2-VASc score. (Level of Evidence: B)" |
| Class IIa |
| "1. Antiarrhythmic medications can be useful to prevent recurrent AF in patients with HCM. Amiodarone, or disopyramide combined with a beta blocker or nondihydropyridine calcium channel antagonists are reasonable therapies. (Level of Evidence: C)" |
| "2. AF catheter ablation can be beneficial in patients with HCM in whom a rhythm-control strategy is desired when antiarrhythmic drugs fail or are not tolerated. (Level of Evidence: B)" |
| Class IIb |
| "1. Sotalol, dofetilide, and dronedarone may be considered for a rhythm-control strategy in patients with HCM. (Level of Evidence: C)" |
7.4 AF Complicating Acute Coronary Syndrome
| Class I |
| "1. Urgent direct-current cardioversion of new-onset AF in the setting of ACS is recommended for patients with hemodynamic compromise, ongoing ischemia, or inadequate rate control. (Level of Evidence: C)" |
| "2. Intravenous beta blockers are recommended to slow a rapid ventricular response to AF in patients with ACS who do not display HF, hemodynamic instability, or bronchospasm. (Level of Evidence: C)" |
| "3. For patients with ACS and AF with CHA2DS2-VASc score of 2 or greater, anticoagulation with warfarin is recommended unless contraindicated. (Level of Evidence: C)" |
| Class IIb |
| "1. Administration of amiodarone or digoxin may be considered to slow a rapid ventricular response in patients with ACS and AF associated with severe LV dysfunction and HF or hemodynamic instability. (Level of Evidence: C)" |
| "2. Administration of nondihydropyridine calcium antagonists might be considered to slow a rapid ventricular response in patients with ACS and AF only in the absence of significant HF or hemodynamic instability. (Level of Evidence: C)" |
7.5 Hyperthyroidism
| Class I |
| "1. Beta blockers are recommended to control ventricular rate in patients with AF complicating thyrotoxicosis unless contraindicated. (Level of Evidence: C)" |
| "2. In circumstances in which a beta blocker cannot be used, a nondihydropyridine calcium antagonist is recommended to control the ventricular rate. (Level of Evidence: C)" |
7.6 AF Complicating Acute Coronary Syndrome
| Class I |
| "1. A nondihydropyridine calcium antagonist is recommended to control the ventricular rate in patients with AF and chronic obstructive pulmonary disease. (Level of Evidence: C)" |
| "2. Direct-current cardioversion should be attempted in patients with pulmonary disease who become hemodynamically unstable as a consequence of new onset AF. (Level of Evidence: C)" |
7.7 Wolff-Parkinson-White and Pre-Excitation Syndromes
| Class I |
| "1. Prompt direct-current cardioversion is recommended for patients with AF, WPW, and rapid ventricular response who are hemodynamically compromised. (Level of Evidence: C)" |
| "2. Intravenous procainamide or ibutilide to restore sinus rhythm or slow the ventricular rate is recommended for patients with pre-excited AF and rapid ventricular response who are not hemodynamically compromised. (Level of Evidence: C)" |
| "3. Catheter ablation of the accessory pathway is recommended in symptomatic patients with pre-excited AF, especially if the accessory pathway has a short refractory period that allows rapid antegrade conduction. (Level of Evidence: C)" |
| Class III: No Benefit |
| "1. Administration of intravenous amiodarone, adenosine, digoxin (oral or intravenous), or nondihydropyridine calcium antagonists (oral or intravenous) in patients with WPW syndrome who have pre-excited AF is potentially harmful as these treatments accelerate the ventricular rate. (Level of Evidence: B)" |
7.8 Heart Failure
| Class I |
| "1. Control of resting heart rate using either a beta blocker or a nondihydropyridine calcium antagonist is recommended for patients with persistent or permanent AF and compensated HF with preserved EF. (Level of Evidence: B)" |
| "2. In the absence of pre-excitation, intravenous beta blocker administration (or a nondihydropyridine calcium antagonist in patients with HFpEF) is recommended to slow the ventricular response to AF in the acute setting, with caution needed in patients with overt congestion, hypotension, or HF with reduced LVEF. (Level of Evidence: B)" |
| "3. In the absence of pre-excitation, intravenous digoxin or amiodarone is recommended to control heart rate acutely in patients with HF. (Level of Evidence: B)" |
| "4. Assessment of heart rate control during exercise and adjustment of pharmacological treatment to keep the rate in the physiological range is useful in symptomatic patients during activity. (Level of Evidence: C)" |
| "5. Digoxin is effective to control resting heart rate in patients with HF with reduced EF. (Level of Evidence: C)" |
| Class III: Harm |
| "1. AV node ablation should not be performed without a pharmacological trial to achieve ventricular rate control. (Level of Evidence: B)" |
| "2. For rate control, intravenous nondihydropyridine calcium antagonists, intravenous beta blockers, and dronedarone should not be administered to patients with decompensated HF. (Level of Evidence: B)" |
| Class IIa |
| "1. A combination of digoxin and a beta blocker (or a nondihydropyridine calcium antagonist for patients with HFpEF), is reasonable to control resting and exercise heart rate in patients with AF. (Level of Evidence: B)" |
| "2. It is reasonable to perform AV node ablation with ventricular pacing to control heart rate when pharmacological therapy is insufficient or not tolerated. (Level of Evidence: B)" |
| "3. Intravenous amiodarone can be useful to control the heart rate in patients with AF when other measures are unsuccessful or contraindicated. (Level of Evidence: C)" |
| "4. For patients with AF and rapid ventricular response causing or suspected of causing tachycardia-induced cardiomyopathy, it is reasonable to achieve rate control by either AV nodal blockade or a rhythm-control strategy. (Level of Evidence: B)" |
| "5. For patients with chronic HF who remain symptomatic from AF despite a rate-control strategy, it is reasonable to use a rhythm-control strategy. (Level of Evidence: C)" |
| Class IIb |
| "1. Oral amiodarone may be considered when resting and exercise heart rate cannot be adequately controlled using a beta blocker (or a nondihydropyridine calcium antagonist in patients with HFpEF) or digoxin, alone or in combination. (Level of Evidence: C)" |
| "2. AV node ablation may be considered when the rate cannot be controlled and tachycardia-mediated cardiomyopathy is suspected. (Level of Evidence: C)" |
7.9 Familial (Genetic) AF
| Class IIb |
| "1. For patients with AF and multigenerational family members with AF, referral to a tertiary care center for genetic counseling and testing may be considered. (Level of Evidence: C)" |
7.10 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)" |
Sources
References
- ↑ 1.0 1.1 1.2 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.