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Management of postoperative atrial fibrillation after cardiac surgery

Ha, Andrew C.T.; Mazer, Cyril David; Verma, Subodh; Yanagawa, Bobby; Verma, Atul

Current Opinion in Cardiology: March 2016 - Volume 31 - Issue 2 - p 183–190
doi: 10.1097/HCO.0000000000000264
VALVULAR HEART DISEASE: Edited by Subodh Verma
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Purpose of review Postoperative atrial fibrillation (POAF) occurs commonly after cardiac surgery and is associated with a number of adverse outcomes. This article will review the available evidence on the prevention and treatment of atrial fibrillation after cardiac surgery. Using this knowledge, we propose a conceptual framework on the management of patients with POAF during various phases after cardiac surgery.

Recent findings Perioperative β-blockade is the cornerstone in preventing POAF after cardiac surgery. Results from randomized trials do not support routine use of colchicine or corticosteroids to prevent POAF. There is no study examining the impact of rate versus rhythm control on ‘hard’ clinical outcomes such as mortality or stroke in the cardiac surgical population. Furthermore, there is a paucity of research on the optimal timing and choice of oral anticoagulation among POAF cardiac surgical patients who are at risk for stroke.

Summary In spite of the plethora of therapies available to treat and prevent POAF in the cardiac surgical population, there is little data to address whether they can improve key clinical outcomes such as death or stroke. Guideline recommendations on rate/rhythm control and oral anticoagulation for stroke prevention in the cardiac surgical population are largely extrapolated from studies of nonsurgical atrial fibrillation patients. Further research is needed to address these key atrial fibrillation management issues specific to the cardiac surgical population.

aPeter Munk Cardiac Centre, University Health Network

bDepartment of Medicine, University of Toronto

cDepartment of Anesthesia, University of Toronto

dLi Ka Shing Knowledge Institute, St Michael's Hospital

eDepartment of Surgery, University of Toronto

fDivision of Cardiac Surgery, St Michael's Hospital, Toronto

gDivision of Cardiology, Southlake Regional Health Centre, Newmarket, Canada

Correspondence to Andrew C.T. Ha, MD, Peter Munk Cardiac Centre, University Health Network, 200 Elizabeth Street 3GW-558A, Toronto, ON, Canada. Tel: +416 340 5206; fax: +416 340 3340; e-mail: andrew.ha@uhn.ca

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