Atrial Fibrillation After Cardiac Surgery
Ahmed Eid El Ghazaly;
Abstract
Atrial fibrillation is the most common arrhythmic complication after coronary artery bypass graft. Although atrial fibrillation is a benign arrhythmia it may contribute to the morbidity, high cost and prolonged hospital stay.
The prevalence of POAF varies from 30% after isolated coronary artery bypass surgery (CABG) to 40% after valve surgery and 50% after combined CABG and valve surgery. POAF normally develops between days 2 and 4 after surgery, with the maximum incidence on postoperative day 2 .
Numerous causative factors have been described without any single factor being singled out as the cause of this complication. POAF has been associated with stroke, renal failure and congestive heart failure, although it is difficult to state whether POAF is directly responsible for these complications .
Identifying patients at risk of POAF would be useful in initiating prophylactic measures. Risk factors associated with POAF include valvular heart disease, right or left atrial dilatation, right coronary artery stenosis, preoperative digoxin use, male gender, history of rheumatic heart disease, left ventricular hypertrophy, diabetes mellitus, type of surgery, duration of surgery and prolonged aortic cross-clamp time .
Patients who develop POAF often experience other postoperative complications. Associations have been documented between AF and ventricular arrhythmias, perioperative myocardial infarction, congestive heart failure, need for permanent pacemaker implantation, renal insufficiency, infection, pneumonia, prolonged mechanical ventilation, increased need for tracheostomy, need for intra-aortic balloon pump, increased postoperative bleeding and cardiac tamponade. The incidence of stroke in association with POAF is threefold higher .
A number of pharmacological and non-pharmacological methods are available for prevention of POAF, but most of the anti-arrhythmic drugs used for prevention of AF have their own drawbacks and side effects, so these drugs and prophylactic measures should be instituted only in patients at higher risk of developing this complication rather than apply these measures as a routine for all patients undergoing cardiac surgery .
The therapeutic goals in the treatment of POAF include prevention of thromboembolism, control of ventricular rate, and conversion and maintenance of sinus rhythm .
The prevalence of POAF varies from 30% after isolated coronary artery bypass surgery (CABG) to 40% after valve surgery and 50% after combined CABG and valve surgery. POAF normally develops between days 2 and 4 after surgery, with the maximum incidence on postoperative day 2 .
Numerous causative factors have been described without any single factor being singled out as the cause of this complication. POAF has been associated with stroke, renal failure and congestive heart failure, although it is difficult to state whether POAF is directly responsible for these complications .
Identifying patients at risk of POAF would be useful in initiating prophylactic measures. Risk factors associated with POAF include valvular heart disease, right or left atrial dilatation, right coronary artery stenosis, preoperative digoxin use, male gender, history of rheumatic heart disease, left ventricular hypertrophy, diabetes mellitus, type of surgery, duration of surgery and prolonged aortic cross-clamp time .
Patients who develop POAF often experience other postoperative complications. Associations have been documented between AF and ventricular arrhythmias, perioperative myocardial infarction, congestive heart failure, need for permanent pacemaker implantation, renal insufficiency, infection, pneumonia, prolonged mechanical ventilation, increased need for tracheostomy, need for intra-aortic balloon pump, increased postoperative bleeding and cardiac tamponade. The incidence of stroke in association with POAF is threefold higher .
A number of pharmacological and non-pharmacological methods are available for prevention of POAF, but most of the anti-arrhythmic drugs used for prevention of AF have their own drawbacks and side effects, so these drugs and prophylactic measures should be instituted only in patients at higher risk of developing this complication rather than apply these measures as a routine for all patients undergoing cardiac surgery .
The therapeutic goals in the treatment of POAF include prevention of thromboembolism, control of ventricular rate, and conversion and maintenance of sinus rhythm .
Other data
| Title | Atrial Fibrillation After Cardiac Surgery | Other Titles | الرجفان الأذيني بعد جراحات القلب | Authors | Ahmed Eid El Ghazaly | Issue Date | 2014 |
Recommend this item
Similar Items from Core Recommender Database
Items in Ain Shams Scholar are protected by copyright, with all rights reserved, unless otherwise indicated.