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==Overview==
==Overview==
Post-[[surgery|operative]] [[atrial fibrillation]] is common in [[heart|cardiac]] or non-[[heart|cardiac]] [[surgery|surgeries]]. The [[incidence]] of [[atrial fibrillation]] in post-[[coronary artery bypass surgery]] ([[CABG]]) and non-[[heart|cardiac]] [[surgery]] [[patients]] are 20%-50% and 0.4%-12%, respectively. [[pain]] and [[inflammation]] due to [[surgery]], [[hypovolemia]] and [[hypervolemia]], [[anemia]], [[hypoxemia]], [[hypomagnesemia]] and [[hypokalemia]] are some of the known factors in [[pathogenesis]] of [[atrial fibrillation]] after [[surgery]]. Although [[atrial fibrillation]] can develop within any time after [[surgery]], it's [[incidence]] is higher between second and fifth [[surgery|postoperative]] day. [[old age|Advanced age]], [[male]] gender, [[obesity]], history of [[chronic obstructive pulmonary disease]], [[valvular heart disease]] and [[chronic renal failure]] are some of the [[risk factors]] of [[surgery|post operative]] [[atrial fibrillation]]. To address [[surgery|post operative]] [[atrial fibrillation]] there are both [[pharmacology|pharmacological]] and non-[[pharmacology|pharmacological]] [[treatments]]. 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]]. Based on a study, using [[Intravenous therapy|intravenous]] [[analgesics]] in [[patients]] who has pulmonary resection [[surgery]] showed significantly lower rates of [[surgery|postoperative]] [[atrial fibrillation]], compared to the control group.


==Postoperative Atrial fibrillation==
==Postoperative Atrial fibrillation==

Latest revision as of 04:39, 3 September 2021



Resident
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Guide
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Sinus rhythm
Atrial fibrillation

Atrial Fibrillation Microchapters

Home

Patient Information

Overview

Historical Perspective

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Pathophysiology

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Differentiating Atrial Fibrillation from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Special Groups

Postoperative AF
Acute Myocardial Infarction
Wolff-Parkinson-White Preexcitation Syndrome
Hypertrophic Cardiomyopathy
Hyperthyroidism
Pulmonary Diseases
Pregnancy
ACS and/or PCI or valve intervention
Heart failure

Diagnosis

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Physical Examination

Laboratory Findings

Electrocardiogram

EKG Examples
A-Fib with LBBB

Chest X Ray

Echocardiography

Holter Monitoring and Exercise Stress Testing

Cardiac MRI

Treatment

Rate and Rhythm Control

Cardioversion

Overview
Electrical Cardioversion
Pharmacological Cardioversion

Anticoagulation

Overview
Warfarin
Converting from or to Warfarin
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Maintenance of Sinus Rhythm

Surgery

Catheter Ablation
AV Nodal Ablation
Surgical Ablation
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Specific Patient Groups

Primary Prevention

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Supportive Trial Data

Cost-Effectiveness of Therapy

Case Studies

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Postoperative atrial fibrillation On the Web

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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: Anahita Deylamsalehi, M.D.[2] Cafer Zorkun, M.D., Ph.D. [3]; Varun Kumar, M.B.B.S.

Overview

Post-operative atrial fibrillation is common in cardiac or non-cardiac surgeries. The incidence of atrial fibrillation in post-coronary artery bypass surgery (CABG) and non-cardiac surgery patients are 20%-50% and 0.4%-12%, respectively. pain and inflammation due to surgery, hypovolemia and hypervolemia, anemia, hypoxemia, hypomagnesemia and hypokalemia are some of the known factors in pathogenesis of atrial fibrillation after surgery. Although atrial fibrillation can develop within any time after surgery, it's incidence is higher between second and fifth postoperative day. Advanced age, male gender, obesity, history of chronic obstructive pulmonary disease, valvular heart disease and chronic renal failure are some of the risk factors of post operative atrial fibrillation. To address post operative atrial fibrillation there are both pharmacological and non-pharmacological treatments. 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. Based on a study, using intravenous analgesics in patients who has pulmonary resection surgery showed significantly lower rates of postoperative atrial fibrillation, compared to the control group.

Postoperative Atrial fibrillation


 
 
 
 
 
 
 
 
 
 
 
 
 
pain due to surgery
 
 
 
 
 
 
 
Hypovolemia, Anemia, Hypoxemia
 
 
 
 
 
 
 
 
 
 
 
 
Hypothermia, Hypoglycemia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Sympathetic outflow elevation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Myoardial damage
 
 
 
 
 
Post-operative atrial fibrillation
 
 
 
 
 
Hypokalemia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hypervolemia
 
 
 
 
 
 
 
 
Inflammation due to surgery
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hypomagnesemia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)[22]

Postoperative Cardiac and Thoracic Surgery

Class I
"1. Treating patients who develop atrial fibrillation 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 atrial fibrillation.(Level of Evidence: B)"
Class IIa
"1. Preoperative administration of amiodarone reduces the incidence of atrial fibrillation in patients undergoing cardiac surgery and is reasonable as prophylactic therapy for patients at high risk for postoperative atrial fibrillation. (Level of Evidence: A)"
"2. It is reasonable to restore sinus rhythm pharmacologically with ibutilide or direct-current cardioversion in patients who develop postoperative atrial fibrillation, 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 atrial fibrillation, as advised for other patients who develop atrial fibrillation. (Level of Evidence: B)"
"4. It is reasonable to administer antithrombotic medication in patients who develop postoperative atrial fibrillation, as advised for nonsurgical patients. (Level of Evidence: B)"
"5. It is reasonable to manage well-tolerated, new-onset postoperative atrial fibrillation with rate control and anticoagulation with cardioversion if atrial fibrillation 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 atrial fibrillation following cardiac surgery. (Level of Evidence: B)"
"2. Administration of colchicine may be considered for patients postoperatively to reduce atrial fibrillation 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)[23][24]

Postoperative AF (DO NOT EDIT)[23][24]

Class I
"1. Unless contraindicated, treatment with an oral beta blocker to prevent postoperative atrial fibrillation 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 atrial fibrillation. (Level of Evidence: B)"
Class IIa
"1. Preoperative administration of amiodarone reduces the incidence of atrial fibrillation in patients undergoing cardiac surgery and represents appropriate prophylactic therapy for patients at high risk for postoperative atrial fibrillation. (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 atrial fibrillation 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 atrial fibrillation, as recommended for other patients who develop atrial fibrillation. (Level of Evidence: B)"
"4. It is reasonable to administer antithrombotic medication in patients who develop postoperative atrial fibrillation, 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 atrial fibrillation following cardiac surgery. (Level of Evidence: B)"

References

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  8. 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.
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  11. Mathew JP, Parks R, Savino JS, Friedman AS, Koch C, Mangano DT; et al. (1996). "Atrial fibrillation following coronary artery bypass graft surgery: predictors, outcomes, and resource utilization. MultiCenter Study of Perioperative Ischemia Research Group". JAMA. 276 (4): 300–6. PMID 8656542.
  12. Piechowiak M, Banach M, Ruta J, Barylski M, Rysz J, Bartczak K; et al. (2006). "Risk factors for atrial fibrillation in adult patients in long-term observation following surgical closure of atrial septal defect type II". Thorac Cardiovasc Surg. 54 (4): 259–63. doi:10.1055/s-2006-923955. PMID 16755448.
  13. Morsi A, Lau C, Nishimura S, Goldman BS (1998). "The development of sinoatrial dysfunction in pacemaker patients with isolated atrioventricular block". Pacing Clin Electrophysiol. 21 (7): 1430–4. doi:10.1111/j.1540-8159.1998.tb00214.x. PMID 9670187.
  14. 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
  15. Echahidi N, Pibarot P, O'Hara G, Mathieu P (2008). "Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery". J Am Coll Cardiol. 51 (8): 793–801. doi:10.1016/j.jacc.2007.10.043. PMID 18294562.
  16. Kaireviciute D, Aidietis A, Lip GY (2009). "Atrial fibrillation following cardiac surgery: clinical features and preventative strategies". Eur Heart J. 30 (4): 410–25. doi:10.1093/eurheartj/ehn609. PMID 19174427.
  17. 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
  18. Podrid PJ (1999) Prevention of postoperative atrial fibrillation: what is the best approach? J Am Coll Cardiol 34 (2):340-2. PMID: 10440142
  19. 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
  20. 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
  21. 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
  22. 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.
  23. 23.0 23.1 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.
  24. 24.0 24.1 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


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