Prevention of atrial fibrillation after cardiac surgery.

PURPOSE OF REVIEW

Atrial fibrillation after cardiac surgery remains a very common and vexing clinical problem. This review summarizes recent clinical and laboratory investigations, the results of which may lead to a more effective strategy for the prevention of atrial fibrillation after cardiac surgery.

RECENT FINDINGS

The incidence of atrial fibrillation after cardiac surgery remains high (60% in some series), and there is no single strategy that reliably prevents it. Age, prior history, valvular surgery, and left atrial pathology and dysfunction are associated with the development of postoperative atrial fibrillation. Mortality in patients who develop new-onset atrial fibrillation after cardiac surgery is increased. Drug treatment with beta-blockers, amiodarone, statins, steroids, magnesium, and sotalol can be effective in preventing postoperative atrial fibrillation. Current guidelines for the prevention of postoperative atrial fibrillation are underutilized, which offers an opportunity for improvement. A new drug, vernakalant, has proved effective and well tolerated for chemical conversion of atrial fibrillation after cardiac surgery to sinus rhythm.

SUMMARY

Atrial fibrillation after cardiac surgery remains a dysrhythmia with significant implications. A more comprehensive, multimodal preventive strategy, using preoperative beta-blockers and statins, perioperative magnesium and steroids, and preoperative amiodarone in high-risk patients should be rigorously evaluated.