Atrial fibrillation remains one of the most common adverse events to occur following cardiac surgery. Despite the improvement in the rate of other perioperative morbidities and mortality, however, the reported incidence of post-operative AF following cardiac surgery remains high (up to 30–50%) and has not changed significantly over recent years. Its incidence increases in those with an increased age, undergoing surgery of increased complexity or with a past history of AF, and is associated with a significant increase in perioperative morbidity, hospital length of stay, utilisation of health care resources and mortality.
The exact mechanisms of initiation and maintenance of post-cardiac surgery AF, however, are not fully understood and associated with this, a number of different treatment modalities and strategies (rate or rhythm control) have been proposed. A rate control strategy includes using medications (such as beta-blockers or calcium channel blockers) that reduce conduction across the atrioventricular node to slow the heart rate, whereas rhythm control strategies include using pharmacological agents (such as amiodarone) or electrical cardioversion in an attempt to restore sinus rhythm. Other considerations for these patients include identification and treatment of any triggers of atrial fibrillation, such as restoration of serum potassium and magnesium levels; anticoagulation, whilst balancing bleeding risks with thromboembolic risks; and the haemodynamic status of the patient, where early electrical cardioversion may be required in patients with hypotension or marked tachycardia.
Due to the absence of robust clinical studies, the implementation of these different management strategies varies considerably. This chapter intends to examine the clinical evidence surrounding the different therapeutic options used in the treatment of atrial fibrillation following cardiac surgery and develop some recommendations regarding how best to manage these patients.
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