Prevention of Atrial Fibrillation after Cardiac Surgery

Abstract

Absolute incidence rates for postoperative AF vary depending on many variables including types of procedures, patient demographics, criteria for diagnosis and methods of ECG monitoring. Many studies were done to determine incidence, actual predictors, management for atrial fibrillation together with the impact on ICU stay, morbidity and mortality during hospital course. Studies showed the strong impact of hypertension & dyslipidemia together with hyperthyroidism from the medical history, left ventricular hypertrophy, myocardial infarction, premature atrial contractions & conduction defect in the ECG preoperative. Post-operative leucocytosis, pericardial inflammation,lowoxygen saturation,hypercarbia, hypoxia, palpitation, ECG changes, hypokalemia, hypomagnesemia leads strongly to atrial fibrillation together with inotropes and pain. B-Blocker, sotalol, amiodarone or statin has role in prevention of post operative AF. B-Blocker most effective when provided both before and after surgery. Amiodarone decreased incidence of postoperative AF and ventricular arrhythmias. Sotalol has been reported to reduce incidence of postoperative AF but it had no impact on hospital stay. Several retrospective studies have reported no effect of ACEIs and ARBs on occurrence of postoperative AF. Hemodynamically stable patients, the majority will convert spontaneously to sinus rhythm within 24 hours. Initial management includes correction of predisposing factors (such as pain, electrolytes disturbances, metabolic abnormalities or hypoxia). In highly symptomatic patients or when rate control is difficult to achieve, electrical or pharmacological cardioversion may be performed. Current indications for curative ablation of AF are limited to patients who remain symptomatic despite the use of antiarrhythmic agents.