Atrial fibrillation following cardiac surgery

Atrial tachyarrhythmias, usually atrial fibrillation or atrial flutter, are the most common complications of cardiac surgery. Atrial tachyarrhythmias are associated with patient discomfort/anxiety, hemodynamic deterioration, cognitive impairment, thromboembolic events (including stroke), exposure to the risks of antiarrhythmic treatments, longer hospital stays and increased costs. Many approaches to the prevention of postoperative atrial tachyarrhythmias have been studied. Of these, studies using perioperative beta-blocking agents or amiodarone provide level A evidence of efficacy and, in properly selected patients, have shown a high degree of safety. Less convincing, level B evidence exists for the use of postoperative temporary atrial pacing and for perioperative intravenous magnesium treatment. The treatment of postoperative atrial tachyarrhythmias is similar to those occurring in other settings and includes excluding other potential causes of atrial tachyarrhythmias, antithrombotic or anticoagulation therapy, control of the ventricular response rate and consideration of restoring/maintaining sinus rhythm. The selection of therapies to achieve these goals should consider the sympathetic nervous system discharge state of the postoperative environment and the natural history of postoperative atrial fibrillation, which includes spontaneous resolution of the arrhythmogenic tendency after approximately six weeks. The Canadian Cardiovascular Society Consensus Conference recommendations for the prevention of atrial tachyarrhythmias after cardiac surgery and for the treatment of atrial tachyarrhythmias that occur after cardiac surgery are presented along with evidence that supports these recommendations.