Post Op AFib

[JLAJHART]

I am aware that nationally, approximately 35% of patients present with post op afib. What if anything are your facilities doing to manage this? Amiodarone has long been the standard once afib presents but with the negative side affects and how slow it is to act, I would think that 50mg metoprolo or brevibloc given before the afib presents would decrease or eliminate it.

Any input or studies you have would be appreciated.

[limaRN, BSN, RN]

I believe that the only thing technically proven to prevent afib after cardiac surgery is beta blockers. You always have to look at HR and bp obviously before giving them. We start pts on 12.5 mg lopressor either night of or day after and increase as tolerated.

[HouTx, BSN, MSN, EdD]

Conservative tx is always best... no need for anything unless pt. is symptomatic or rhythm is persistent. Hey, I'm speaking from experience here. Had a RL lobectomy in Sept with 'classic' atrial arrhythmias for about 3 weeks afterward. They resolved as the inflammation subsided. No tx necessary.

[limaRN, BSN, RN]

Conservative tx is always best... no need for anything unless pt. is symptomatic or rhythm is persistent. Hey I'm speaking from experience here. Had a RL lobectomy in Sept with 'classic' atrial arrhythmias for about 3 weeks afterward. They resolved as the inflammation subsided. No tx necessary.[/quote']

You're absolutely right. Unfortunately, those post-op CABG pts are symptomatic when they go into afib d/t loss of "atrial kick" and cardiac indices may drop, you may have issues with bp and need to go up on pressors. However, if it is rate controlled and the pt otherwise tolerates it we typically don't treat except for thinking about anti coagulation in a reasonable amount of time after surgery.

[dah doh, BSN, RN]

Our ct surgeons prefer Amiodarone initially, beta block post op day 1 or 2. Occasionally overdrive pacing or atrial pacing and shocking on the rare occasion. Anticoagulants for valves. It depends on how well the patient tolerates the afib too.

[andi.w]

We use IV amio after the pt goes into afib. We start a beta blocker POD 1 if the pt can tolerate it. Otherwise, we are not currently doing anything preventative.