Document Detail


Pharmacologic control of rhythm: American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillation after cardiac surgery.
MedLine Citation:
PMID:  16167665     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Of the 128 articles evaluated on the overall topic of atrial fibrillation (AF) after cardiac surgery, only 19 studies dealing with pharmacologic heart rhythm control were relevant for inclusion in this analysis, indicating the relative paucity of evidence-based studies addressing this topic. We found limited data on guiding treatment for the rhythm control of AF following cardiac surgery in patients who do not require urgent cardioversion; therefore, the choice of an antiarrhythmic drug needs to be guided by patient characteristics. Based on limited available evidence, amiodarone is recommended for pharmacologic conversion of postoperative AF and AFL in patients with depressed left ventricular function who do not need urgent electrical cardioversion. This recommendation is made largely because of the effectiveness of amiodarone and also because of its relatively favorable side-effects profile. Sotalol and class 1A antiarrhythmic drugs are reasonable choices for patients with coronary artery disease who do not have congestive heart failure. There are currently no definitive data to guide the decision about the duration of antiarrhythmic drug therapy for patients with AF following cardiac surgery. Most protocols continue therapy with the antiarrhythmic drug for 4 to 6 weeks following surgery, but evidence from randomized studies is lacking.
Authors:
Elizabeth A Martinez; Eric B Bass; Peter Zimetbaum;
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Chest     Volume:  128     ISSN:  0012-3692     ISO Abbreviation:  Chest     Publication Date:  2005 Aug 
Date Detail:
Created Date:  2005-09-19     Completed Date:  2005-10-11     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  48S-55S     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesia, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / administration & dosage,  pharmacology,  therapeutic use
Anti-Arrhythmia Agents / administration & dosage,  pharmacology,  therapeutic use*
Atrial Fibrillation / etiology*,  prevention & control*
Calcium Channel Blockers / administration & dosage,  pharmacology,  therapeutic use
Cardiac Surgical Procedures / adverse effects*
Drug Administration Schedule
Heart Conduction System / drug effects
Humans
Practice Guidelines as Topic
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Anti-Arrhythmia Agents; 0/Calcium Channel Blockers

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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