Key result
Despite available therapies for postoperative atrial fibrillation, there is little data on whether they improve key clinical outcomes such as death or stroke in the cardiac surgical population.
Current management of postoperative atrial fibrillation after cardiac surgery relies heavily on perioperative beta-blockade, while evidence for rate versus rhythm control and anticoagulation is largely extrapolated from non-surgical populations, highlighting a critical need for targeted research.
Current postoperative AF management should not yet change practice; leaves open critical gaps for dedicated trials on death and stroke.
PURPOSE OF REVIEW: Postoperative atrial fibrillation (POAF) occurs commonly after cardiac surgery and is associated with a number of adverse outcomes. This article will review the available evidence on the prevention and treatment of atrial fibrillation after cardiac surgery. Using this knowledge, we propose a conceptual framework on the management of patients with POAF during various phases after cardiac surgery. RECENT FINDINGS: Perioperative β-blockade is the cornerstone in preventing POAF after cardiac surgery. Results from randomized trials do not support routine use of colchicine or corticosteroids to prevent POAF. There is no study examining the impact of rate versus rhythm control on 'hard' clinical outcomes such as mortality or stroke in the cardiac surgical population. Furthermore, there is a paucity of research on the optimal timing and choice of oral anticoagulation among POAF cardiac surgical patients who are at risk for stroke. SUMMARY: In spite of the plethora of therapies available to treat and prevent POAF in the cardiac surgical population, there is little data to address whether they can improve key clinical outcomes such as death or stroke. Guideline recommendations on rate/rhythm control and oral anticoagulation for stroke prevention in the cardiac surgical population are largely extrapolated from studies of nonsurgical atrial fibrillation patients. Further research is needed to address these key atrial fibrillation management issues specific to the cardiac surgical population.
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Ha et al. (2016) conducted a review in Postoperative atrial fibrillation after cardiac surgery. Despite available therapies for postoperative atrial fibrillation, there is little data on whether they improve key clinical outcomes such as death or stroke in the cardiac surgical population.
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