Postoperative Atrial Fibrillation

This chapter focuses on postoperative atrial fibrillation (POAF), which is very common after cardiothoracic surgery. Prevention of POAF involves continuation of preoperative beta-blockers, initiation of postoperative beta-blockers, and consideration of initiation of preoperative amiodarone in high-risk groups. In all patients, initial management of POAF includes correcting hypoxia and electrolyte abnormalities and consideration of weaning stimulating agents such as inotrope infusions. Medical management of hemodynamically stable patients includes the use of rate control agents such as beta-blockers, calcium-channel blockers, and digoxin or rhythm control agents such as amiodarone. When the patient is hemodynamically unstable, emergent synchronized cardioversion should be performed. Meanwhile, in refractory cases of rapid POAF, an aggressive rate control strategy may be pursued using one or more medications, but this approach must be weighed against the risk of requiring temporary or permanent pacing. Atrial flutter also occurs after cardiothoracic surgery, though at lower rates than POAF. It may be managed similarly to POAF, but it is typically more amenable to electrical cardioversion.