Interventions on Prevention of Postoperative Atrial Fibrillation in Patients Undergoing Heart Surgery

Abstract

Background-Postoperative atrial fibrillation (AF) is a common complication of cardiac surgery and has been associated with increased incidence of other complications and increased hospital length of stay (LOS). Prevention of AF is a reasonable clinical goal, and, consequently, many randomized trials have evaluated the effectiveness of pharmacological and nonpharmacological interventions for prevention of AF. To better understand the role of various prophylactic therapies against postoperative AF, a systematic review of evidence from randomized trials was performed. Methods and Results-Fifty-two randomized trials (controlled by placebo or routine treatment) of ␤-blockers, sotalol, amiodarone, or pacing were identified by systematic literature search.

Guidelines on myocardial revascularization

“…Dosages vary widely between trials based on body size and LV function. As shown by several RCTs and meta-analyses [183,184,186], amiodarone is effective for the prophylaxis of AF. The largest RCT reported atrial tachyarrhythmias in 16.1% of amiodarone-treated patients compared with 29.5% of placebo-treated patients (HR 0.52, 95% CI 0.34 0.69), a 13.4% absolute risk reduction [184].…”

“…b-blockers, sotalol, and amiodarone reduce the risk of post-operative AF [183,184]. There is a wealth of safety and efficacy data, including two recent meta-analyses, supporting the routine use of b-blockers in post-operative cardiac surgical patients to reduce the incidence of post-operative AF (OR 0.36, 95% CI 0.28 0.47) [185,186].…”

Intravenous Plus Oral Amiodarone, Atrial Septal Pacing, or Both Strategies to Prevent Post-Cardiothoracic Surgery Atrial Fibrillation: The Atrial Fibrillation Suppression Trial II (AFIST II)

“…2 Beta-blocker prophylaxis reduces the incidence of AF post-CTS. 3,4 Despite beta-blocker use, the incidence of AF remains approximately 30% and could be due to inadequate dosing clinically and the withdrawal of beta-blockade before postoperative day 3. 2,[5][6][7] Amiodarone, sotalol, and biatrial pacing are acceptable alternative strategies.…”

“…2,[5][6][7] Amiodarone, sotalol, and biatrial pacing are acceptable alternative strategies. 3 In the Atrial Fibrillation Suppression Trial (AFIST), we compared oral amiodarone to placebo. 7 Amiodarone was given in either a 5-or 1-day preoperative loading regimen followed by therapy for 5 postoperative days (delivering 7g or 6g total, respectively).…”

Prevenção de fibrilação atrial com amiodarona em moderada dosagem no pós-operatório de cirurgia cardíaca é segura e eficaz em pacientes de alto risco para desenvolver essa arritmia

“…It is known that the more risk factors, the greater the likelihood of atrial fibrillation in the postoperative period of cardiac surgery 12,13 .…”