title: [Prophylaxis and therapy for atrial fibrillation after general thoracic surgery].
abstract: Following thoracic surgery atrial fibrillation (AF) frequently occurs in 12 to 44 % of cases postoperatively and is related to an increased morbidity and mortality. In 2011, the Society of Thoracic Surgeons of the United States published guidelines for the prophylaxis and treatment of postoperative AF. High evidence levels are provided for continuing β-blocker treatment despite its known negative inotropic effects. Alternatively, the calcium channel blocker diltiazem, or amiodarone for patients without pneumonectomy are recommended for prophylactic therapy. For rate control of AF occurring post surgery, not only selective β1-blockers, calcium channel blockers, but also magnesium or digoxin are suitable in haemodynamically stable patients. Amiodarone, β1-blockers and flecainide are preferred for rhythm control in case of haemodynamic stability in regard to possible side effects and contraindications. In contrast, electrical cardioversion is indicated in those patients with haemodynamic instability. Persistent AF of > 48 hours is a target for anticoagulation treatment depending on the individual aspects of the patient and in accordance to the CHADS2 score. The present review article further discusses the evidence for the recommended medical therapy and treatment strategies.
authors.affiliation: Abteilung für Pneumologie, Intensiv- und Beatmungsmedizin, Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Universität Witten-Herdecke, Köln, Deutschland.
authors.forename: C
authors.initials: C
authors.lastname: Karagiannidis
authors.affiliation: Abteilung für Kardiologie, Angiologie und Internistische Intensivmedizin, Klinikum Köln-Merheim, Kliniken der Stadt Köln gGmbH, Akademisches Lehrkrankenhaus der Universität Köln, Köln, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Meissner
authors.affiliation: Abteilung für Thoraxchirurgie, Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Universität Witten-Herdecke, Köln, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Koryllos
authors.affiliation: Abteilung für Pneumologie, Intensiv- und Beatmungsmedizin, Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Universität Witten-Herdecke, Köln, Deutschland.
authors.forename: W
authors.initials: W
authors.lastname: Windisch
authors.affiliation: Abteilung für Pneumologie, Intensiv- und Beatmungsmedizin, Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Universität Witten-Herdecke, Köln, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Strassmann
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000517:prevention & control; D003131:Combined Modality Therapy; D004554:Electric Countershock; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006801:Humans; D011183:Postoperative Complications / Q000188:drug therapy* / Q000517:prevention & control; D019616:Thoracic Surgical Procedures
chemical_list: D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants