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Eur J Cardiothorac Surg 2006;30:852-872
© 2006 Elsevier Science NL

Guidelines on the prevention and management of de novo atrial fibrillation after cardiac and thoracic surgery

^a James Cook University Hospital, Middlesbrough, UK
^b Guy's Hospital, London, UK
^c Leiden University Medical Center, The Netherlands
^d Papworth Hospital, Cambridge, UK

Received 12 April 2006; received in revised form 28 July 2006; accepted 4 September 2006.

^_* Corresponding author. Address: Papworth Hospital, Cambridge CB3 8RE, UK. Tel.: +44 1480 364299; fax: +44 1480 364744. (Email: sam.nashef@papworth.nhs.uk).

The first 300 words of the full text of this article appear below.

	1. Executive summary

 

• This document presents a professional view of evidence-based prevention and treatment of a commonly occurring arrhythmia after heart and chest operations. It was prepared by the Audit and Guidelines Committee of the European Association for Cardio-Thoracic Surgery (EACTS).

• The document does not deal with the primary planned surgical treatment of paroxysmal or chronic atrial dysrhythmias as a presenting feature, but focuses on patients who develop de novo atrial arrhythmia after surgical intervention in the chest (maze and other ablation procedures are outside the remit of this guideline).

• There are several and varied manoeuvres, interventions and drug treatments in current use for this condition. This document reviews all the available evidence for efficacy and safety of these modalities of prevention and treatment and assesses the quality and quantity of the available evidence for each modality in a uniform and structured manner. Based on the available evidence, an algorithm is presented to summarise an acceptable protocol for use in patients having cardiac surgery (the largest sub-group of patients).

• The guideline is subject to continuous informal review, if and when new evidence becomes available. The formal review date will be at 5 years from publication (September 2011).

	2. Introduction

 
Post-operative atrial fibrillation (AF) is a common complication after cardiac and thoracic surgery with 20–40% of patients suffering from this complication. AF increases the risk of mortality and morbidity from stroke, heart failure, myocardial infarction, thromboembolism, bleeding from anticoagulation and hospital readmission [1–4]. Patients who suffer AF post-operatively also have greater length of stay and, from the patient's perspective, the episode is usually symptomatic with palpitations, nausea and malaise. In addition, these patients require more resources, including monitoring, higher dependency care and increased nursing support. Thus, optimal preventive and treatment strategies are of paramount importance to reduce the impact of this . . . [Full Text of this Article]

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