Perioperative atrial fibrillation
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Revision as of 16:19, 7 May 2021 by Aidan (talk | contribs) (Created page with "== Background == * Refers to atrial fibrillation that occurs during or immediately following non-cardiac surgery ** Excludes patients with known persistent or paroxysmal...")
Background
- Refers to atrial fibrillation that occurs during or immediately following non-cardiac surgery
- Excludes patients with known persistent or paroxysmal atrial fibrillation
Clinical Manifestations
- Irregularly irregular heart rhythm with atrial fibrillation on ECG
- High rates of spontaneous cardioversion
Management
- Screen patients with known atrial fibrillation with telemetry for 24 to 48 hours after surgery
- If hemodynamically unstable, consider electric cardioversion as per typical atrial fibrillation
- Rate control with β blockers to target HR <100 bpm (alternatives include calcium channel blockers or digoxin)
- Unclear whether long-term anticoagulation is indicated; the ASPIRE-AF will hopefully answer this question
- Consider evaluating with CHA2DS2-VASc, though not validated in the patient population
- Timing of anticoagulation would need to be discussed with the surgeon
- Arrange outpatient echocardiogram and extended Holter monitor (14 days)
