title: A novel treatment strategy of new onset atrial fibrillation after cardiac surgery: an observational prospective study.
abstract: OBJECTIVE
  The aim of this prospective observational study was to evaluate the efficiency of a new escalating treatment strategy with vernakalant, flecainide and electrical cardioversion (EC) in patients with new onset atrial fibrillation (AF) after cardiac surgery.
  
  
  METHODS
  24 patients with new onset AF after aortic valve surgery, coronary artery bypass surgery or combined procedures were evaluated in this study. Additional including criteria were age between 18 and 80, duration of AF less than four days, body weight less than 100 kg and no previous treatment with class I or III antiarrhythmic drugs. Exclusion criteria were poor left ventricular ejection fraction (LVEF < 40%) and history of myocardial infarction within 30 days. The patients were divided into converters and non-converters according to their response to combination treatment with vernakalant and flecainide, and the groups were compared.
  
  
  RESULTS
  The mean age of the population was 69.6 ± 6.3 years and 26.1% of patients were female. There were no statistically significant differences between the two groups in terms of height, weight, gender distribution, comorbidities, preoperative medication, left ventricular function and left atrium diameter. Interventricular septum (IVS) in the non-converted group was significantly thicker compared to the converted group: 14.0 ± 1.00 vs. 10.40 ± 2.59 mm (p = 0.036). While 14 patients (60.9%) were successfully converted into stable sinus rhythm by pharmacological treatment with vernakalant and flecainide, 9 patients (39.1%, non-converted group) remained in AF. However, seven of them could be converted after additional EC.
  
  
  CONCLUSIONS
  The combination of vernakalant and flecainide improves the conversion rate into a stable sinus rhythm in postcardiotomy patients with new onset AF compared to single drug therapy. Furthermore it might be an excellent precondition for successful EC in patients who are not converted after using both antiarrhtythmic drugs. Furthermore, left ventricular hypertrophy might be a potential negative predictor of successful pharmacological cardioversion.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Zeriouh
authors.affiliation: Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany. anton.sabashnikov@uk-koeln.de.
authors.forename: Anton
authors.initials: A
authors.lastname: Sabashnikov
authors.forename: Yeong-Hoon
authors.initials: YH
authors.lastname: Choi
authors.forename: Javid
authors.initials: J
authors.lastname: Fatullayev
authors.forename: Hannes
authors.initials: H
authors.lastname: Reuter
authors.forename: Aron-Frederik
authors.initials: AF
authors.lastname: Popov
authors.forename: Georg
authors.initials: G
authors.lastname: Langebartels
authors.forename: Lucas
authors.initials: L
authors.lastname: Kimmig
authors.forename: Parwis B
authors.initials: PB
authors.lastname: Rahmanian
authors.forename: Thorsten
authors.initials: T
authors.lastname: Wittwer
authors.forename: Klaus
authors.initials: K
authors.lastname: Neef
authors.forename: Jens
authors.initials: J
authors.lastname: Wippermann
authors.forename: Thorsten
authors.initials: T
authors.lastname: Wahlers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D004554:Electric Countershock / Q000379:methods; D004562:Electrocardiography; D005500:Follow-Up Studies; D011183:Postoperative Complications; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents