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Management
10.9.2. Treatment of AF After Cardiac Surgery
COR LOE
Recommendations
1 A* 1. In postoperative cardiac surgery patients, beta blockers*
are recommended to achieve rate control for AF,
unless contraindicated or ineffective, in which case
a nondihydropyridine calcium channel blocker
†
is
recommended.
B-R
†
1 B-R 2. In hemodynamically stable cardiac surgery patients with
postoperative AF, rate-control (target heart rate <100 bpm)
and/or rhythm- control medications are recommended
as initial therapy, with the choice of strateg y according
to patient symptoms, hemodynamic consequences of the
arrhythmia, and physician preference.
1 B-R 3. In patients who develop poorly tolerated AF after cardiac
surgery, DCCV in combination with AAD therapy is
recommended, with consideration of imaging to rule out left
appendage thrombus before cardioversion in those patients in
whom AF has been present >48 hours and who have not been
on anticoagulation.
2a B-NR 4. In patients who develop postoperative AF after cardiac
surgery, it is reasonable to administer anticoagulation when
deemed safe in regards to surgical bleeding for 60 days after
surgery unless complications develop, and to reevaluate the
need for longer term anticoagulation at that time.
2a C-LD 5. In patients who develop AF after cardiac surgery and who are
treated with rate-control strateg y, at 30- to 60-day follow-up
it is reasonable to perform rhythm assessment and, if AF
does not revert to sinus rhythm spontaneously, consider
cardioversion after an adequate duration of anticoagulation.
* A LOE applies to the data on beta blockers.
†
B-R LOE applies to the data on nondihydropyridine calcium channel blockers.
