Document Detail

The changing face of postoperative atrial fibrillation prevention: a review of current medical therapy.
MedLine Citation:
PMID:  17700382     Owner:  NLM     Status:  MEDLINE    
Atrial fibrillation is the most common postoperative arrhythmia with significant consequences on patient health. Postoperative atrial fibrillation (POAF) complicates up to 8% of all noncardiac surgeries, between 3% and 30% of noncardiac thoracic surgeries, and between 16% and 46% of cardiac surgeries. POAF has been associated with increased morbidity, mortality, and longer, more costly hospital stays. The risk of POAF after cardiac and noncardiac surgery may be affected by several epidemiologic and intraoperative factors, as well as by the presence of preexisting cardiovascular and pulmonary disorders. POAF is typically a transient, reversible phenomenon that may develop in patients who possess an electrophysiologic substrate for the arrhythmia that is present before or as a result of surgery. Numerous studies support the efficacy of beta-blockers in POAF prevention; they are currently the most common medication used in POAF prophylaxis. Perioperative amiodarone, sotalol, nondihydropyridine calcium channel blockers, and magnesium sulfate have been associated with a reduction in the occurrence of POAF. Biatrial pacing is a nonpharmacologic method that has been associated with a reduced risk of POAF. Additionally, recent studies have demonstrated that hydroxymethylglutaryl-CoA reductase inhibitors may decrease the risk of POAF. Finally, based on recent evidence that angiotensin converting enzyme inhibitors and angiotensin receptor blockers reduce the risk of permanent atrial fibrillation, these medications may also hold promise in POAF prophylaxis. However, there is a need for further large-scale investigations that incorporate standard methodologies and diagnostic criteria, which have been lacking in past trials.
Sarah E Mayson; Arnold J Greenspon; Suzanne Adams; Matthew V Decaro; Mital Sheth; Howard H Weitz; David J Whellan
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Cardiology in review     Volume:  15     ISSN:  1538-4683     ISO Abbreviation:  Cardiol Rev     Publication Date:    2007 Sep-Oct
Date Detail:
Created Date:  2007-08-16     Completed Date:  2007-09-06     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9304686     Medline TA:  Cardiol Rev     Country:  United States    
Other Details:
Languages:  eng     Pagination:  231-41     Citation Subset:  IM    
Division of Cardiology, Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA.
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MeSH Terms
Age Factors
Amiodarone / therapeutic use
Angiotensin-Converting Enzyme Inhibitors / therapeutic use
Anti-Arrhythmia Agents / therapeutic use
Atrial Fibrillation / diagnosis,  epidemiology,  etiology,  physiopathology,  prevention & control*
Calcium Channel Blockers / therapeutic use
Cardiac Pacing, Artificial
Cardiac Surgical Procedures / adverse effects
Coronary Artery Bypass / adverse effects
Digoxin / therapeutic use
Heart Conduction System / physiopathology
Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
Magnesium Sulfate / therapeutic use
Postoperative Complications / diagnosis,  epidemiology,  etiology,  physiopathology,  prevention & control*
Practice Guidelines as Topic
Randomized Controlled Trials as Topic
Receptors, Angiotensin / antagonists & inhibitors
Risk Factors
Sex Factors
Sotalol / therapeutic use
Survival Analysis
Thoracic Surgical Procedures / adverse effects
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 0/Anti-Arrhythmia Agents; 0/Calcium Channel Blockers; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors; 0/Receptors, Angiotensin; 1951-25-3/Amiodarone; 20830-75-5/Digoxin; 3930-20-9/Sotalol; 7487-88-9/Magnesium Sulfate

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

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