title: Management of postoperative atrial fibrillation.
abstract: The impact of postoperative atrial fibrillation (PAF) on patient outcomes has prompted intense investigation into the optimal methods for prevention and treatment of this complication. In the prevention of PAF, β-blockers and amiodarone are particularly effective and are recommended by guidelines. However, their use requires caution due to the possibility of drug-related adverse effects. Aside from these risks, perioperative prophylactic treatment with statins seems to be effective for preventing PAF and is associated with a low incidence of adverse effects. PAF can be treated by rhythm control, heart-rate control, and antithrombotic therapy. For the purpose of heart rate control, β-blockers, calcium-channel antagonists, and amiodarone are used. In patients with unstable hemodynamics, cardioversion may be performed for rhythm control. Antithrombotic therapy is used in addition to heart-rate maintenance therapy in cases of PAF >48-h duration or in cases with a history of cerebrovascular thromboembolism. Anticoagulation is the first choice for antithrombotic therapy, and anticoagulation management should focus on maintaining international normalized ratio (INRs) in the 2.0-3.0 range in patients <75 years of age, whereas prothrombin-time INR should be controlled to the 1.6-2.6 range in patients ≥75 years of age. In the future, dabigatran could be used for perioperative management of PAF, because it does not require regular monitoring and has a quick onset of action with short serum half-life. Preventing PAF is an important goal and requires specific perioperative management as well as other approaches. PAF is also associated with lifestyle-related diseases, which emphasizes the ongoing need for appropriate lifestyle management in individual patients.
authors.affiliation: Department of Anesthesiology, Fujimoto Hayasuzu Hospital, Miyakonojo, Miyazaki, Japan. omae@za2.so-net.ne.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Omae
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Kanmura
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000638:Amiodarone / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D047549:Coronary Artery Bypass, Off-Pump; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008274:Magnesium / Q000627:therapeutic use; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*
chemical_list: D000319:Adrenergic beta-Antagonists; D000893:Anti-Inflammatory Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008274:Magnesium; D000638:Amiodarone