Postoperative atrial fibrillation
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Sinus rhythm  |
Atrial fibrillation  | |
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| ICD-10 | I48 |
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| ICD-9 | 427.31 |
| DiseasesDB | 1065 |
| MedlinePlus | 000184 |
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Atrial Fibrillation Microchapters | |
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Cardioversion | |
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Anticoagulation | |
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Surgery | |
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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
The incidence of atrial fibrillation post-CABG is between 20% and 50%.[1][2][3] Predictors of post-operative AF include advanced age, history of COPD, valvular heart disease, left atrial enlargement, peri-operative heart failure and discontinuation of either beta blocker or ACE inhibitors before or after surgery,[4] pericarditis [5] and elevated postoperative adrenergic tone. Paroxysmal form of AF 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.[6] Pre-treatment with either digoxin or verapamil has not shown to prevent postoperative AF.[3][7][8] In hemodynamically unstable patients, AV nodal blocking agents such as short-acting beta-blockers, nondihydropyridine CCBs or intravenous amiodarone [9] has shown to improve hemodynamics in patients with post-operative AF. Post-CABG, there is an increased risk of stroke; hence, heparin or oral anticoagulation may be appropriate if post-op AF persists for longer than 48-hours.[10][11]
ACCF/AHA/HRS 2011 Guidelines- Postoperative AF (DO NOT EDIT) [12][13]
| 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) " |
Vote on and Suggest Revisions to the Current Guidelines
Guideline Resources
- 2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation [13]
- ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter [14]
References
- ↑ 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
- ↑ 3.0 3.1 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
- ↑ 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
- ↑ 12.0 12.1 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
- ↑ 13.0 13.1 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. Circulation 123 (10):e269-367. DOI:10.1161/CIR.0b013e318214876d PMID: 21382897
- ↑ Estes NA, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS et al. (2008) ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Clinical Performance Measures for Atrial Fibrillation): developed in collaboration with the Heart Rhythm Society. Circulation 117 (8):1101-20. DOI:10.1161/CIRCULATIONAHA.107.187192 PMID: 18283199
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