Atrial Fibrillation in Patients After Cardiovascular Surgery

Atrial fibrillation in patients undergoing cardiovascular surgery is a common problem, occurring in 25–50% of patients. Older patients and those with a prior history of atrial fibrillation are at highest risk, as are those patients in whom preoperative treatment with β-blockers has been discontinued. The immediate sequelae of this common complication include hemodynamic instability and congestive heart failure with long-term consequences including thromboembolic phenomena and increased cost and length of hospitalization. β-Blockers, amiodarone, and sotalol have all been shown to decrease the incidence of postoperative atrial fibrillation, but their use may be limited by their adverse effects. Other agents have some promise as prophylactic agents, but need further verification. Biatrial pacing has been shown to be effective, especially when β-blockers are used simultaneously. The goals for the treatment of atrial fibrillation include maintaining hemodynamic stability, controlling ventricular rate, preventing thromboembolic complications, and restoring sinus rhythm. The most effective strategy for the prevention of atrial fibrillation is to identify the highest-risk patients and target them for prophylaxis with β-blockers, amiodarone, sotalol or pacing.