Management of atrial fibrillation in the post-cardiac surgery setting

New onset postcardiac surgery atrial fibrillation (AF) is a prevalent problem associated with increased morbidity, hospital expense, and length of stay. Those agents that inhibit beta-adrenergic receptors (class II beta-blockers, amiodarone and sotalol) have been demonstrated to be successful prophylaxis against postoperative AF. Furthermore, those therapies that do not inhibit beta-receptors are not effective prophylactic therapies. The safety and the incremental prophylactic advantage of sotalol and amiodarone in comparison with beta-blockers have not been demonstrated conclusively. beta-Adrenergic antagonists, therefore, are the drugs of choice for prophylaxis against postcardiac surgery AF. AF occurring in the postoperative period should be managed in a manner similar to clinical AF, with attention to rate control, anticoagulation, and restoration of sinus rhythm.