Perioperative atrial fibrillation: Difference between revisions
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(Created page with "== Background == * Refers to atrial fibrillation that occurs during or immediately following non-cardiac surgery ** Excludes patients with known persistent or paroxysmal...") |
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+ | ==Background== |
| − | * |
+ | *Refers to [[atrial fibrillation]] that occurs during or immediately following non-cardiac surgery |
| − | ** |
+ | **Excludes patients with known persistent or paroxysmal [[atrial fibrillation]] |
| + | *Occurs in 30% after thoracic surgery and in 1-20% of non-thoracic, non-cardiac surgery |
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| − | == |
+ | ==Clinical Manifestations== |
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+ | *Irregularly irregular heart rhythm with atrial fibrillation on ECG, usually within the first 4 days postoperatively |
| − | * |
+ | *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 CHA<sub>2</sub>DS<sub>2</sub>-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) |
[[Category:Perioperative medicine]] |
[[Category:Perioperative medicine]] |
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Latest revision as of 12:21, 7 May 2021
Background
- Refers to atrial fibrillation that occurs during or immediately following non-cardiac surgery
- Excludes patients with known persistent or paroxysmal atrial fibrillation
- Occurs in 30% after thoracic surgery and in 1-20% of non-thoracic, non-cardiac surgery
Clinical Manifestations
- Irregularly irregular heart rhythm with atrial fibrillation on ECG, usually within the first 4 days postoperatively
- 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)
