Cardiothoracic & vascular anesthesia
An Update on Guidelines to Prevent and Manage Atrial Fibrillation After Cardiac Surgery and a Survey of Practice in the UK
Authors' conclusion
Guidance to prevent AF after cardiac surgery centers around the use of β-blockade. Although patients in the UK do not appear to be risk-assessed for POAF, the main interventions used to prevent it are similar: β-blockade and maintenance of serum K+ and Mg2+ levels.
Study context
- Population
- UK NHS cardiac surgery centres; guidelines on prevention and management of atrial fibrillation (AF) after cardiac surgery from UK, Europe and North America31 (89%) responded
- Participants
- 35 participants
- Outcome
- UK practice to prevent POAF and guideline recommendations
Methodological detailsonline survey, national (all 35 UK NHS cardiac surgery centres)
- Online survey
- National (all 35 UK NHS cardiac surgery centres)
Main finding
As reported in the abstract
- Relevant guidelines identified
- 5
- Centres following local guidance for prevention of postoperative atrial fibrillation (POAF)
- 11 of 31 (35.5%)
- Centres following SCA/EACTA guidelines
- 4 (13%)
- Centres following UK NICE guidance
- 4 (13%)
- Centres following other guidance
- 4
- Centres following no guidelines to prevent POAF
- 8 (26%)
- Centres not risk-stratifying patients for POAF
- 28 of 31 (90%)
- Centres without a care package to prevent POAF
- 23/31, 74%
- Centres trying in some way to prevent AF in patients in sinus rhythm
- 14 of 31 (45%)
- Postoperative β-blocker use
- 23/31, 74%
- Magnesium
- 20/31, 64.5%
- Maintaining serum K+ ≥4.5 mmol/L
- 26/31, 84%
Observational data: associations, not effects.
Further findings
Guideline recommendations for management of AF after cardiac surgery
- Treatment with rate or rhythm control
- Cardioversion only for the hemodynamically unstable patient
- Consider anticoagulation if AF persists over 48 hours
- Follow-up within 60 days to review need for antiarrhythmic and anticoagulant therapy
Original publication
An Update on Guidelines to Prevent and Manage Atrial Fibrillation After Cardiac Surgery and a Survey of Practice in the UK. J Cardiothorac Vasc Anesth. Published 26 July 2024. doi:10.
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