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.
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.
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: firstname.lastname@example.org