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==Overview== | ==Overview== | ||
==2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)<ref name="JanuaryWann2014">{{cite journal|last1=January|first1=C. T.|last2=Wann|first2=L. S.|last3=Alpert|first3=J. S.|last4=Calkins|first4=H.|last5=Cleveland|first5=J. C.|last6=Cigarroa|first6=J. E.|last7=Conti|first7=J. B.|last8=Ellinor|first8=P. T.|last9=Ezekowitz|first9=M. D.|last10=Field|first10=M. E.|last11=Murray|first11=K. T.|last12=Sacco|first12=R. L.|last13=Stevenson|first13=W. G.|last14=Tchou|first14=P. J.|last15=Tracy|first15=C. M.|last16=Yancy|first16=C. W.|title=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|journal=Circulation|year=2014|issn=0009-7322|doi=10.1161/CIR.0000000000000041}}</ref>== | ==Postoperative Atrial fibrillation== | ||
*Post-[[surgery|operative]] [[atrial fibrillation]] is common in [[heart|cardiac]] or non-[[heart|cardiac]] [[surgery|surgeries]].<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]] 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> | |||
*[[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> | |||
*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> | |||
*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> | |||
*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> | |||
===2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)<ref name="JanuaryWann2014">{{cite journal|last1=January|first1=C. T.|last2=Wann|first2=L. S.|last3=Alpert|first3=J. S.|last4=Calkins|first4=H.|last5=Cleveland|first5=J. C.|last6=Cigarroa|first6=J. E.|last7=Conti|first7=J. B.|last8=Ellinor|first8=P. T.|last9=Ezekowitz|first9=M. D.|last10=Field|first10=M. E.|last11=Murray|first11=K. T.|last12=Sacco|first12=R. L.|last13=Stevenson|first13=W. G.|last14=Tchou|first14=P. J.|last15=Tracy|first15=C. M.|last16=Yancy|first16=C. W.|title=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|journal=Circulation|year=2014|issn=0009-7322|doi=10.1161/CIR.0000000000000041}}</ref>=== | |||
===Postoperative Cardiac and Thoracic Surgery=== | |||
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Revision as of 19:57, 1 September 2021
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Resident Survival Guide |
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Sinus rhythm  |
Atrial fibrillation  |
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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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Postoperative atrial fibrillation On the Web | |
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Directions to Hospitals Treating Postoperative atrial fibrillation | |
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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: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.
Overview
Postoperative Atrial fibrillation
- Post-operative atrial fibrillation is common in cardiac or non-cardiac surgeries.[1]
- The incidence of atrial fibrillation in post-coronary artery bypass surgery (CABG) patients is between 20% and 50%.[2][3][4]
- The incidence of atrial fibrillation after non-cardiac surgeries is between 0.4% and 12%.[1]
- Atrial fibrillation can develop within any time after surgery. Nevertheless it's incidence is higher between second and fifth postoperative day.[5]
- Predictors of post-operative AF include advanced age, history of chronic obstructive pulmonary disease (COPD), valvular heart disease, left atrial enlargement, peri-operative heart failure and discontinuation of either beta blocker or ACE inhibitors before or after surgery, and elevated postoperative adrenergic tone.[6] pericarditis [7]
- Paroxysmal form of atrial fibrillation is common post-operatively and is usually self-limiting with sinus rhythm resuming by 6-8 weeks post-surgery in more than 90% of patients.[8]
- Pre-treatment with either digoxin or verapamil has not shown to prevent postoperative atrial fibrillation.[4][9][10]
- 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.[11]
- Post-coronary artery bypass surgery (CABG), there is an increased risk of stroke; hence, heparin or oral anticoagulation may be appropriate if post-operative atrial fibrillation persists for longer than 48 hours.[12][13]
2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)[14]
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)[15][16]
Postoperative AF (DO NOT EDIT)[15][16]
| 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
- ↑ 1.0 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.
- ↑ 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
- ↑ Creswell LL, Schuessler RB, Rosenbloom M, Cox JL (1993) Hazards of postoperative atrial arrhythmias. Ann Thorac Surg 56 (3):539-49. PMID: 8379728
- ↑ 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
- ↑ 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.
- ↑ 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
- ↑ 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
- ↑ 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
- ↑ 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
- ↑ Podrid PJ (1999) Prevention of postoperative atrial fibrillation: what is the best approach? J Am Coll Cardiol 34 (2):340-2. PMID: 10440142
- ↑ 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
- ↑ 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
- ↑ 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
- ↑ 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.
- ↑ 15.0 15.1 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.
- ↑ 16.0 16.1 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