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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.
"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.
The guidelines were developed by a multidisciplinary panel of experts in the fields of cardiothoracic surgery, cardiology, anesthesiology, and epidemiology.
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.
"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.
MEDICA.de; Source: American College of Chest Physicians (ACCP)