Back to Cardiology Articles
Thursday 11th August, 2005
The ACCP released the first evidence-based guidelines for the
management of AF after cardiac surgery.
(NORTHBROOK, IL, August 8, 2005) - The American College of
Chest Physicians (ACCP) released today the first evidence-based
clinical practice guidelines for the prevention and management
of postoperative atrial fibrillation (AF) after cardiac surgery.
Published in the August issue of CHEST, the peer-reviewed
journal of the ACCP, the guidelines offer specific
recommendations on cardiac pacing, anticoagulation therapy,
pharmaceutical prophylaxis, intraoperative interventions, and
pharmacologic control of ventricular rate and rhythm. Atrial
fibrillation, or irregular heartbeat, is a common condition that
occurs increasingly with age and is one of the most frequent
complications of cardiac surgery.
"Over one third of patients suffer from
AF after cardiac
surgery, which is associated with a higher risk of operative
morbidity, increased hospital stay, and increased hospital
cost," said Guidelines Co-Chair Peter P. McKeown, MBBS, MPH, MPA,
FCCP, Veterans Affairs Medical Center, Asheville, NC. "Although
previous guidelines have focused on the management of
AF, our guidelines are the first to address
AF associated with
Through the Health and Science Policy Committee of the ACCP,
the guidelines were developed by a multidisciplinary panel of
experts in the fields of cardiothoracic surgery, cardiology,
anesthesiology, and epidemiology. The panel included
representatives from the ACCP, the American College of
Cardiology, the Society of Thoracic Surgeons, and the American
College of Surgeons. Based on a systematic review of randomized,
controlled trials, panel members made graded recommendations
based on the quality of evidence available and the net benefit
of the intervention.
Are you a doctor or a nurse?
Do you want to join the Doctors Lounge online medical community?
Participate in editorial activities (publish, peer review, edit) and
give a helping hand to the largest online community of patients.
Click on the link below to see the requirements:
Doctors Lounge Membership
Recommendations center on the main issues that arise in
managing patients with postoperative AF, including overall
prevention; control of ventricular response rate; restoration of
normal sinus rhythm; and prevention of thromboembolism and the
anticoagulation. Overall, guidelines recommend the use
of beta-blockers over calcium channel blockers, a standard
therapy for chronic AF, for general prevention of postoperative
AF and control of ventricular rate. Guidelines also recommend
against the routine use of magnesium and
digitalis for the
prevention of postoperative AF. Amidarone may be considered for
patients in whom beta-blockers are contraindicated and as
therapy for postoperative sinus rhythm control. Atrial pacing,
the use of a pacemaker to control
arrhythmia, was found to
reduce the incidence of AF after cardiac surgery; however, biatrial pacing is recommended over single atrial pacing.
Additionally, mild hypothermia and heparin-coated circuits are
recommended to reduce the occurrence of
AF during intraoperative
procedures. In regard to the prevention of thromboembolism, the
guidelines recommend cautious
anticoagulation therapy for
patients in whom AF has persisted for more than 48 hours.
"Atrial fibrillation that develops after cardiac surgery
places the patient at risk for thromboembolism and stroke, both
which may require
anticoagulants or blood-thinning agents to
treat. Yet, cardiac surgery may increase a patient's tendency to
bleed," said Guidelines Co-Chair David D. Gutterman, MD, FCCP,
Medical College of Wisconsin, Milwaukee, WI. "Therefore,
anticoagulation therapy should be carefully considered in the
treatment of postoperative AF, with the risks of bleeding
balanced with the risk of embolic
"The development and implementation of clinical practice
guidelines allow clinicians to practice medicine based on the
highest quality of data available," said Paul A. Kvale, MD, FCCP,
President of the American College of Chest Physicians. "Although
recommendations for the prevention and management of
postoperative atrial fibrillation are intended to guide
clinicians in their health-care decisions, they can be adapted
to address issues of individual patient circumstance."
To order a copy of American College of Chest Physicians
Guidelines for the Prevention and Management of Postoperative
Atrial Fibrillation After Cardiac Surgery, or for more
information, contact the ACCP at (800) 343-ACCP (2227).
CHEST is a peer-reviewed journal published by the ACCP.
|Article reviewed by: