Management of atrial fibrillation following cardiac surgery:
Observational study and development of a standardised protocol
Abstract
Rationale, aims and objectives: Postoperative atrial fibrillation (POAF)
is the most common complication occurring after cardiac surgery.
Guidelines for the management of this complication are scarce, often
resulting in differences in treatment strategy use among patients. The
aims of this study were to evaluate the management of POAF in a cardiac
surgery department, characterise the extent of its variability and
develop a standardised protocol. Methods: Data from patients who
underwent cardiac surgeries with subsequent POAF between 1 January 2017
and 1 June 2018 were analysed in this single-centre observational
retrospective study. The primary outcome was the difference in the
proportions of patients whose first POAF episodes were treated with a
rate control (RaC) strategy, a rhythm control (RhC) strategy and both
among hospital units (intensive care unit [ICU], intermediate care
unit [IMCU] and general ward [GW]). Secondary outcomes included
the mean duration of POAF episodes, POAF recurrences, and the management
of anticoagulation. Results: Data from 97 patients were included in this
study. The POAF management strategy differed significantly among
hospital units (ICU: RhC 75.0%, RhC and RaC 19.4%, RaC 0.0%; IMCU:
RhC 40.4%, RhC and RaC 34.6%, RaC 13.5%; GW: RhC 22.2%, RhC and RaC
33.3%, RaC 44.4%; p = 0.001). Ninety-five (97.9%) patients converted
to sinus rhythm after the first POAF episode; 51.2% of these
conversions occurred within 8 h after onset. POAF recurred in 56.7% of
patients. Considering all POAF episodes, 83 (85.6%) patients received
amiodarone as part of the RhC strategy. Based on these results, a
hospital working group developed a standardised protocol for POAF
management. Conclusions: POAF management was heterogeneous at our
institution. This paper highlights the need for clear practice
guidelines based on large prospective studies to provide care according
to best practices for all patients undergoing cardiac surgery.