New Guidelines Target Postoperative Atrial Fibrillation

The American College of Chest Physicians on Monday released the first evidence-based guidelines to address the prevention and management of atrial fibrillation (AF) after cardiac surgery.
"Over one third of patents suffer from AF after cardiac surgery, which is associated with a higher risk of operative morbidity, increased hospital stay, and increased hospital cost," guideline co-chair Dr. Peter P. McKeown, from the VA Medical Center in Asheville, North Carolina, said in an ACCP statement. "Although previous guidelines have focused on the management of chronic AF, our guidelines are the first to address AF associated with cardiac surgery," he added.
The guidelines, which appear in the August issue of Chest, stem from a systematic review of randomized controlled trials and offer specific recommendations on a number of relevant topics, such as the use of cardiac pacing and anticoagulation therapy.
In their analysis, the researchers conclude that beta-blockers are superior to calcium channel blockers in preventing postoperative AF as well as controlling the ventricular rate.
The guidelines advise against the routine use of magnesium and digitalis for preventing AF after cardiac surgery. Amiodarone, however, is a suitable choice for patients with contraindications to beta-blockers or when sinus rhythm control is needed.
Atrial pacing was found to reduce the occurrence of AF after cardiac surgery and further analysis indicated that biatrial pacing was preferable to single atrial pacing.
To help prevent AF during intraoperative procedures, the guidelines recommend the use of mild hypothermia and heparin-coated circuits. To prevent postoperative thromboembolism, cautious anticoagulation therapy is indicated if the AF persists for longer than 48 hours.
"The development and implementation of clinical practice guidelines allow clinicians to practice medicine based on the highest quality of data available," Dr. Paul A. Kvale, President of the American College of Chest Physicians, said in the statement.
Chest 2005;125:1S-8S.
Source: Reuter

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