Common complication following surgery

The evidence-based clinical practice guidelines for the prevention and management of postoperative atrial fibrillation (AF) after cardiac surgery have been released by the American College of Chest Physicians, Northbrook, Ill. They 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 following 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," cautions Peter P. McKeown of the Veterans Affairs Medical Center, Asheville, N.C.

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; prevention of thromboembolism; and the role of anticoagulation. Overall, guidelines suggest 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.

"Atrial fibrillation that develops after cardiac surgery places the patient at risk for thromboembolism and stroke, both of which may require anticoagulants or blood-thinning agents to treat. Yet, cardiac surgery may increase a patient's tendency to bleed," observes David D. Gutterman of the Medical College of Wisconsin, Milwaukee. "Therefore, anticoagulation therapy should be carefully considered in the treatment of postoperative AF, with the risks of bleeding balanced [against] the risk of embolic stroke."

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