Researchers from American College of Chest Physicians (ACCP) had provided clinical guidelines for chest physicians who deal with prevention and management of postoperative atrial fibrillation (AF) after cardiac surgery. Their report was published in the latest issue of journal Chest. The researchers offer specific guidelines relating to cardiac pacing, anticoagulation therapy , pharmaceutical prophylaxis, intraoperative interventions, and pharmacologic control of ventricular rate and rhythm.
Over one third of patients suffer from AF after cardiac surgery, which is associated with a higher risk of operative morbidity, increased hospital stay, and increased hospital cost. Although previous guidelines have focused on the management of chronic AF, the new guidelines are the first to address AF associated with cardiac surgery, said the researchers.
The guidelines were developed by a multidisciplinary panel of experts in the fields of cardiothoracic surgery, cardiology, anesthesiology, and epidemiology. The panel included representatives from the ACCP, the American College of Cardiology, the Society of Thoracic Surgeons, and the American College of Surgeons. Based on a systematic review of randomized, controlled trials, panel members made graded recommendations based on the quality of evidence available and the net benefit of the intervention.
Recommendations center on the main issues that arise in managing patients with postoperative AF, including overall prevention; control of ventricular response rate; restoration of normal sinus rhythm; and prevention of thromboembolism and the role of anticoagulation. Overall, guidelines recommend the use of beta-blockers over calcium channel blockers, a standard therapy for chronic AF, for general prevention of postoperative AF and control of ventricular rate. Guidelines also recommend against the routine use of magnesium and digitalis for the prevention of postoperative AF.