Cardiac surgery: Postoperative arrhythmias

Arrhythmias are common after surgery, particularly after cardiac surgery. Atrial fibrillation is the most common arrhythmia encountered postoperatively, although ventricular arrhythmias and conduction disturbances can also occur. Older age is the most consistent predictor of postoperative atrial arrhythmias. beta-adrenergic blockers, amiodarone, and sotalol are the most effective at preventing postoperative atrial fibrillation. Sustained ventricular arrhythmias in the recovery period after cardiac surgery warrant aggressive therapy, usually with an implantable cardioverter-defibrillator in the absence of reversible causes. Postoperative, nonsustained ventricular tachycardia in the setting of left ventricular dysfunction and ischemic coronary disease also usually warrants risk stratification and possible treatment, often with electrophysiologic testing and implantation of an implantable cardioverter-defibrillator, if sustained ventricular arrhythmias are induced. Transient bradyarrhythmias may be managed with temporary pacing wires placed at surgery, but significant and persistent atrioventricular block or sinus node dysfunction can occur and indicate a need for permanent pacing.