Postoperative atrial fibrillation

Tachy-arrhythmias may be treated with a /3i-selective blocker. Sotalol may be used in the treatment of postoperative atrial fibrillation, which is observed frequently following cardiac surgery. 

Class II Ventricular tachycardia WPW syndrome Postoperative atrial fibrillation (i.v. amiodarone)... 

Unlabeled Uses Control of hemodynamicallystableventriculartachycardia, control of rapid ventricular rate due to accessory pathway conduction in preexcited atrial arrhythmias, conversion of atrial fibrillation to normal sinus rhythm, in cardiac arrest with persistent ventricular tachycardia or ventricular fibrillation, paroxysmal supraventricular tachycardia, polymorphic ventricular tachycardia or wide complex tachycardia of uncertain origin, prevention of postoperative atrial fibrillation... 

Carnes CA, Chung MK, Nakayama T, Nakayama H, Baliga RS, Piao S, Kan-derian A, Pavia S, Hamlin RL, McCarthy PM, Bauer JA, Van Wagoner DR. Ascorbate attenuates atrial pacing-induced peroxynitrite formation and electrical remodeling and decreases the incidence of postoperative atrial fibrillation. Circ Res 2001 89 E32-E38. 

In a meta-analysis of five randomized, placebo-con-trolled trials of amiodarone 200-1200 mg/day for 2-7 days in the treatment of postoperative atrial fibrillation and flutter in 764 patients, the incidence of adverse events with amiodarone was no greater than with placebo (27). 

Crystal E, ConnoUy SJ, Sleik K, et al. Interventions on prevention of postoperative atrial fibrillation in patients undergoing heart surgery. Circulation 2002 106 75-80. 

Cardiovascular Atrial fibrillation Postoperative atrial fibrillation is a frequent complication after cardiac surgery. Inotropic drugs are commonly used perioperatively... 

Fleming GA, Murray KT, Yu C, Byrne JG, Greelish JP, Petracek MR, Hoff SJ, Ball SK, Brown NJ, Pretorius M. Milrinone use is associated with postoperative atrial fibrillation after cardiac surgery. Circulation 2008 118(16) 1619-25. 

Looking at safety of these concentrates, analysis of 3 studies found adverse events in 3 of 26 patients receiving fibrinogen concentrate, whereas 12 of the 27 control patients experienced an adverse event [120 ]. The three reported adverse events were subclinical PE, vein graft occlusion and postoperative atrial fibrillation. One of the studies included in this analysis did not report safety data. Going forward, it will be important for studies to consider issues of threshold, clinical situation, role of testing and documentation of adverse events [121 ]. 

Rodrigo R, Korantzopoulos P, Cereceda M, Asenjo R, Zamorano J, ViUalabeitia E, et al. A randomized controlled trial to prevent postoperative atrial fibrillation by antioxidant reinforcement. J Am CoU Cardiol October 15,2013 62(16) 1457-65. 

Digoxin, prototype of the cardiac glycosides, is frequently used postoperatively for the management of atrial fibrillation. This effect is based on the impairment of AV conduction and unrelated to digoxin s positive inotropic activity. In the treatment of post-operative atrial fibrillation digoxin may be... 

Morady F. Prevention of atrial fibrillation in the postoperative cardiac patient significance of oral class III anti-arrhythmic agents. Am J Cardiol 1999 84(9A) R156-60. 

Indicators provide a quantitative measure of an aspect of patient care that can be used in monitoring, evaluating, and improving the quality and appropriateness of healthcare delivery. An indicator may serve as a screen or red flag to identify a potential problem (postoperative infection rate, number of serious medication errors) or measure progress toward an established goal (percent of patients with atrial fibrillation who are anticoagulated). 

The second form of chronic therapy to be considered (at least in those patients in whom maintenance of sinus rhythm is a goal) is antiarrhythmic drugs to prevent recurrences of atrial fibrillation. With some exceptions (postoperative situations), atrial fibrillation often recurs after initial cardioversion because most patients have irreversible underlying heart or lung disease. Large atrial size, poor LV function, and the presence of long-standing atrial fibrillation are factors that make the restoration and maintenance of sinus rhythm difficult, if not... 

Heparin is an anticoagulant that inhibits reactions that lead to clotting. It is indicated in prophylaxis and treatment of venous thrombosis and its extensions, pulmonary embolism (PE), peripheral arterial embolism, and atrial fibrillation with embolization diagnosis and treatment of acute and chronic consumption coagulopathies (DIC) and prevention of postoperative deep venous thrombosis. 

A 56-year-old man with hypertension suffered a 62% total body surface area burn (day 0) and on day 4 developed atrial fibrillation with a rapid ventricular rate, which was treated with amiodarone and digoxin. After pyloroplasty for a bleeding ulcer on day 20, he developed a postoperative ileus and was given metoclopramide 20 mg intravenously every 6 hours. Beginning on day 54, he started to have episodes of bradycardia and asystole. Some episodes required atropine and others resolved spontaneously. Some converted initially to a junctional rhythm, but all ultimately reverted to sinus tachycardia. Digoxin and metoclopramide were withdrawn and several hours later the bradydysrhythmias stopped. 

In a non-randomized prospective study of 1188 patients who underwent cardiac surgery, the first 596 received aprotinin and the next 592 received tranexamic acid [198 ]. Postoperatively, in those who underwent primary valve surgery, tranexamic acid was associated with significantly higher incidences of seizures (4.6% versus 1.2%), persistent atrial fibrillation (7.9% versus 2.3%), and renal insufficiency (9.7% versus 1.7%). In those who underwent primary... 

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