SCA/EACT 2019 Practice Advisory for Mx of Perioperative AF i
Postoperative atrial fibrillation (poAF) is the most common adverse event after cardiac surgery and is associated with increased morbidity, mortality, and hospital and intensive care unit length of stay. Despite progressive improvements in overall cardiac surgical operative mortality and postoperative morbidity, the incidence of poAF has remained unchanged at 30%-50%.

In an effort to improve the perioperative management of atrial fibrillation (AF), the Society of Cardiovascular Anesthesiologists (SCA) and the European Association of Cardiothoracic Anaesthetists (EACTA) present a best practice advisory incorporating existing guidelines. The guidance document has been published recently in the journal Anesthesia and Analgesia.

The recommendations are:-
• Perioperative oral β-blocker therapy is recommended for the prevention of postoperative AF after cardiac surgery

• A nondihydropyridine calcium channel blocker or β-blocker is recommended to achieve rate control with postoperative AF

• Restoration of sinus rhythm by electrical cardioversion or antiarrhythmic drugs is recommended in postoperative AF with hemodynamic instability

• Perioperative amiodarone should be considered to prevent AF after cardiac surgery

• Asymptomatic postoperative AF should initially be managed with rate control and anticoagulation

• Long-term anticoagulation should be considered in patients with postoperative AF, considering individual stroke and bleeding risk

• Antiarrhythmic drugs or direct current cardioversion should be considered for symptomatic postoperative AF after cardiac surgery in an attempt to restore sinus rhythm

• Intravenous vernakalant may be considered for cardioversion of postoperative AF in patients without severe heart failure, hypotension, or severe structural heart disease (especially aortic stenosis)

• Colchicine may be considered postoperatively to reduce AF after cardiac surgery

• Statin use prevents postoperative AF but is equivocal

• Digoxin does not reduce postoperative AF

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