title: Management of postoperative atrial fibrillation after cardiac surgery.
abstract: OBJECTIVE
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: aPeter Munk Cardiac Centre, University Health Network bDepartment of Medicine, University of Toronto cDepartment of Anesthesia, University of Toronto dLi Ka Shing Knowledge Institute, St Michael's Hospital eDepartment of Surgery, University of Toronto fDivision of Cardiac Surgery, St Michael's Hospital, Toronto gDivision of Cardiology, Southlake Regional Health Centre, Newmarket, Canada.
authors.forename: Andrew C T
authors.initials: AC
authors.lastname: Ha
authors.forename: Cyril David
authors.initials: CD
authors.lastname: Mazer
authors.forename: Subodh
authors.initials: S
authors.lastname: Verma
authors.forename: Bobby
authors.initials: B
authors.lastname: Yanagawa
authors.forename: Atul
authors.initials: A
authors.lastname: Verma
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000494:pharmacology*; D000925:Anticoagulants / Q000494:pharmacology*; D001281:Atrial Fibrillation / Q000209:etiology / Q000517:prevention & control; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D018890:Chemoprevention / Q000379:methods; D006801:Humans; D054539:Medication Therapy Management; D017063:Outcome Assessment, Health Care; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control*; D020521:Stroke / Q000209:etiology / Q000517:prevention & control
chemical_list: D000319:Adrenergic beta-Antagonists; D000925:Anticoagulants