Prophylactic therapy to prevent atrial arrhythmia after cardiac surgery.
OBJECTIVE
Atrial fibrillation after cardiac surgery is associated with adverse outcomes and increased costs. Accordingly, therapy should be provided to prevent postoperative atrial fibrillation. The evaluation of therapies to do so is an area of active investigation with significant recent advances. The purpose of this review is to summarize these recent advances in the context of our previous knowledge base regarding the prevention of postoperative atrial fibrillation.


RESULTS
Recent evaluations of therapy to prevent postoperative atrial fibrillation have raised the prominence of prophylactic amiodarone, redefined the efficacy of prophylactic standard beta-blockers in contemporary cardiac surgical populations, provided further evidence for the use of prophylactic sotalol, magnesium, and atrial pacing, and identified new approaches, including the use of combination therapy, for the prevention of postoperative atrial fibrillation.


CONCLUSIONS
According to newly released ACC/AHA/ESC guidelines, use of standard beta-blockers or amiodarone to prevent postoperative atrial fibrillation have a level of evidence of A. Use of prophylactic sotalol has a level of evidence of B, while the use of prophylactic intravenous magnesium or atrial pacing has a lower level of evidence. The use of novel and combination therapies continues to be an area of active investigation.
Mitchell
L Brent
LB
Libin Cardiovascular Institute of Alberta, Calgary Health Region, Department of Cardiac Sciences, University of Calgary, Canada. brent.mitchell@calgaryhealthregion.ca
D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000191:economics; D003131:Combined Modality Therapy / Q000379:methods; D023381:Endpoint Determination; D006325:Heart Atria; D007902:Length of Stay; D008274:Magnesium / Q000627:therapeutic use; D013015:Sotalol / Q000627:therapeutic use
D000889:Anti-Arrhythmia Agents; D013015:Sotalol; D008274:Magnesium; D000638:Amiodarone