Canadian Cardiovascular Society Atrial Fibrillation Guidelines 2010: Prevention and Treatment of Atrial Fibrillation Following Cardiac Surgery

• Published in: Canadian journal of cardiology 2011, Vol.27 (1), p.91-97
• Main Author: Mitchell, L. Brent, MD, FRCPC
• Format: Article
• Language: English
• Subjects: Adrenergic beta-Antagonists - adverse effects; Adrenergic beta-Antagonists - therapeutic use; Amiodarone - adverse effects; Amiodarone - therapeutic use; Anti-Arrhythmia Agents - adverse effects; Anti-Arrhythmia Agents - therapeutic use; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Atrial Fibrillation - drug therapy; Atrial Fibrillation - etiology; Atrial Fibrillation - prevention & control; Atrial Flutter - drug therapy; Atrial Flutter - etiology; Atrial Flutter - prevention & control; Canada; Cardiac Pacing, Artificial; Cardiovascular; Contraindications; Drug Therapy, Combination; Evidence-Based Medicine; Heart Diseases - surgery; Humans; Intensive Care Units; Length of Stay; Magnesium Sulfate - therapeutic use; Postoperative Complications - drug therapy; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Premedication; Randomized Controlled Trials as Topic; Risk Factors
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2010.11.005

Abstract Postoperative atrial fibrillation and atrial flutter (POAF) are the most common complications of cardiac surgery that require intervention or prolong intensive care unit and total hospital stay. For some patients, these tachyarrhythmias have important consequences including patient discomfort/anxiety, hemodynamic deterioration, cognitive impairment, thromboembolic events including stroke, exposure to the risks of antiarrhythmic treatments, longer hospital stay, and increased health care costs. We conclude that prevention of POAF is a worthwhile exercise and recommend that the dominant therapy for this purpose be β-blocker therapy, especially the continuation of β-blocker therapy that is already in place. When β-blocker therapy is contraindicated, amiodarone prophylaxis is recommended. If both of these therapies are contraindicated, therapy with either intravenous magnesium or biatrial pacing is suggested. Patients at high risk of POAF may be considered for first-line amiodarone therapy, first-line sotalol therapy, or combination prophylactic therapy. The treatment of POAF may follow either a rate-control approach (with the dominant therapy being β-blocking drugs) or a rhythm-control approach. Anticoagulation should be considered if persistent POAF lasts >72 hours and at the point of hospital discharge. The ongoing need for any POAF treatment (including anticoagulation) should be reconsidered 6-12 weeks after the surgical procedure.