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Atrial fibrillation after cardiac surgery: where are we now?

Patel D, Gillinov MA, Natale A - Indian Pacing Electrophysiol J (2008)

Bottom Line: POAF is associated with an increased risk of morbidity and mortality, and longer hospital stay.Prophylactic treatments reduce the likelihood of POAF.All other patients should be managed with rate strategies.

View Article: PubMed Central - PubMed

Affiliation: St. David's Medical Center,Austin, TX 78744, USA. dimpi.patel@stdavids.com

ABSTRACT

Objective: To review: 1) Pathophysiology of postoperative atrial fibrillation (POAF); 2) Risk factors for POAF; 3) Prophylaxis of POAF; 4) Treatment of POAF; and 5) Future directions.

Methods: We searched the Medline database for articles published between January, 1966 to September, 2008. We used the following keywords: Atrial fibrillation, Postoperative atrial fibrillation, Coronary Artery Bypass, and antiarrhythmic agents. Additionally, we searched references from all relevant articles.

Conclusions: POAF occurs in 25-60% of patients depending on the type of cardiac surgery performed. POAF generally occurs on postoperative day 2 or 3. POAF is associated with an increased risk of morbidity and mortality, and longer hospital stay. Prophylactic treatments reduce the likelihood of POAF. In patients who experience POAF, rhythm strategies should be used in those who are symptomatic and hemodynamically unstable. All other patients should be managed with rate strategies.

No MeSH data available.


Related in: MedlinePlus

Beta blockers versus placebo or no treatment for the prevention of AF.  Test for heterogeneity P=0.00001.  Test for overall effect P<0.00001.  Published with permission from Crystal E, Connolly S, Sleik K et al.  Interventions on Prevention of Postoperative Atrial Fibrillation in Patients Undergoing Heart Surgery:  A Meta-Analysis.  Circulation 2002;106:75-80.
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Figure 2: Beta blockers versus placebo or no treatment for the prevention of AF. Test for heterogeneity P=0.00001. Test for overall effect P<0.00001. Published with permission from Crystal E, Connolly S, Sleik K et al. Interventions on Prevention of Postoperative Atrial Fibrillation in Patients Undergoing Heart Surgery: A Meta-Analysis. Circulation 2002;106:75-80.

Mentions: β-receptor antagonists (Vaughan-Williams class II) reduce the likelihood of developing POAF in many studies. Increased sympathetic tone may predispose a patient to POAF and β-receptor antagonists target this pathway. A meta-analysis of 27 studies evaluating 3,840 patients compared ß-receptor antagonist versus placebo for POAF prevention. (Figure 2). There was a 14% reduction in incidence POAF between the control group and β-receptor antagonist group P<0.00001. Furthermore, patients receiving long-term β -receptor antagonist therapy prior to cardiac surgery and who do not continue β-receptor antagonist postoperatively have a higher incidence of POAF. Therefore, unless specifically contradicted, reinitiation of β-receptor antagonists should not be postponed. Interestingly, two β-receptor antagonist trials including 1200 patients showed no significant reduction in the length of hospital stay (-0.66 days; 95% CI, -2.04 to 0.72) (Figure 3). Trials have also compared β-receptor antagonists to digitalis, propafenone, and diltaziem. The findings from these studies were not conclusive due to small sample size [2,22].


Atrial fibrillation after cardiac surgery: where are we now?

Patel D, Gillinov MA, Natale A - Indian Pacing Electrophysiol J (2008)

Beta blockers versus placebo or no treatment for the prevention of AF.  Test for heterogeneity P=0.00001.  Test for overall effect P<0.00001.  Published with permission from Crystal E, Connolly S, Sleik K et al.  Interventions on Prevention of Postoperative Atrial Fibrillation in Patients Undergoing Heart Surgery:  A Meta-Analysis.  Circulation 2002;106:75-80.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2572025&req=5

Figure 2: Beta blockers versus placebo or no treatment for the prevention of AF. Test for heterogeneity P=0.00001. Test for overall effect P<0.00001. Published with permission from Crystal E, Connolly S, Sleik K et al. Interventions on Prevention of Postoperative Atrial Fibrillation in Patients Undergoing Heart Surgery: A Meta-Analysis. Circulation 2002;106:75-80.
Mentions: β-receptor antagonists (Vaughan-Williams class II) reduce the likelihood of developing POAF in many studies. Increased sympathetic tone may predispose a patient to POAF and β-receptor antagonists target this pathway. A meta-analysis of 27 studies evaluating 3,840 patients compared ß-receptor antagonist versus placebo for POAF prevention. (Figure 2). There was a 14% reduction in incidence POAF between the control group and β-receptor antagonist group P<0.00001. Furthermore, patients receiving long-term β -receptor antagonist therapy prior to cardiac surgery and who do not continue β-receptor antagonist postoperatively have a higher incidence of POAF. Therefore, unless specifically contradicted, reinitiation of β-receptor antagonists should not be postponed. Interestingly, two β-receptor antagonist trials including 1200 patients showed no significant reduction in the length of hospital stay (-0.66 days; 95% CI, -2.04 to 0.72) (Figure 3). Trials have also compared β-receptor antagonists to digitalis, propafenone, and diltaziem. The findings from these studies were not conclusive due to small sample size [2,22].

Bottom Line: POAF is associated with an increased risk of morbidity and mortality, and longer hospital stay.Prophylactic treatments reduce the likelihood of POAF.All other patients should be managed with rate strategies.

View Article: PubMed Central - PubMed

Affiliation: St. David's Medical Center,Austin, TX 78744, USA. dimpi.patel@stdavids.com

ABSTRACT

Objective: To review: 1) Pathophysiology of postoperative atrial fibrillation (POAF); 2) Risk factors for POAF; 3) Prophylaxis of POAF; 4) Treatment of POAF; and 5) Future directions.

Methods: We searched the Medline database for articles published between January, 1966 to September, 2008. We used the following keywords: Atrial fibrillation, Postoperative atrial fibrillation, Coronary Artery Bypass, and antiarrhythmic agents. Additionally, we searched references from all relevant articles.

Conclusions: POAF occurs in 25-60% of patients depending on the type of cardiac surgery performed. POAF generally occurs on postoperative day 2 or 3. POAF is associated with an increased risk of morbidity and mortality, and longer hospital stay. Prophylactic treatments reduce the likelihood of POAF. In patients who experience POAF, rhythm strategies should be used in those who are symptomatic and hemodynamically unstable. All other patients should be managed with rate strategies.

No MeSH data available.


Related in: MedlinePlus