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Anesth Analg. 2019 Jan;128(1):33-42. doi: 10.1213/ANE.0000000000003865.

Society of Cardiovascular Anesthesiologists/European Association of Cardiothoracic Anaesthetists Practice Advisory for the Management of Perioperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery.

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From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
Department of Anesthesiology, Perioperative Care, and Pain Medicine, New York University Langone Health, New York, New York.
Division of Cardiology, University of Washington, Seattle, Washington.
Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Department of Cardiology, South Tampa Center for Advanced Healthcare, Tampa, Florida.
Department of Anesthesiology, Missoula Anesthesiology, Missoula, Montana.
Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina.
Department of Anesthesiology Education and Research Anesthesiology, Lehigh Valley Hospital, Allentown, Pennsylvania.
Department of Anesthesiology, Ronald Reagan University of California Los Angeles (UCLA) Medical Center, UCLA Medical Center, Santa Monica, California.
Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Division of Cardiothoracic Surgery, Brown Medical School and Rhode Island Hospital, Providence, Rhode Island.
Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.
Department of Perioperative Medicine, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.


Postoperative atrial fibrillation (poAF) is the most common adverse event after cardiac surgery and is associated with increased morbidity, mortality, and hospital and intensive care unit length of stay. Despite progressive improvements in overall cardiac surgical operative mortality and postoperative morbidity, the incidence of poAF has remained unchanged at 30%-50%. A number of evidence-based recommendations regarding the perioperative management of atrial fibrillation (AF) have been released from leading cardiovascular societies in recent years; however, it is unknown how closely these guidelines are being followed by medical practitioners. In addition, many of these society recommendations are based on patient stratification into "normal" and "elevated" risk groups for AF, but criteria for that stratification have not been clearly defined. In an effort to improve the perioperative management of AF, the Society of Cardiovascular Anesthesiologists (SCA) Clinical Practice Improvement Committee developed a multidisciplinary Atrial Fibrillation Working Group that created a summary of current best practice based on a distillation of recent guidelines from professional societies involved in the care of cardiac surgical patients. An evidence-based set of survey questions was then generated to describe the current practice of perioperative AF management. Through collaboration with the European Association of Cardiothoracic Anaesthetists (EACTA), that survey was distributed to the combined memberships of both the SCA and EACTA, yielding 641 responses and resulting in the most comprehensive understanding to date of perioperative AF management in North America, Europe, and beyond. The survey data demonstrated the broad range of therapies utilized for the prevention and treatment of poAF, as well as a spectrum of adherence to published guidelines. With the goal of improving adherence, a graphical advisory tool was created with an easily accessible format that could be utilized for bedside management. Finally, given that no evidence-based threshold currently exists to differentiate patients at normal risk to develop poAF from those at elevated risk, the SCA/EACTA AF working group created a list of poAF risk factors using expert opinion and based on published risk score models for poAF. This approach allows stratification of patients into risk groups and facilitates adherence to the evidence-based recommendations summarized in the graphical advisory tool. It is our hope that these new additions to the clinical toolkit for the management of perioperative AF will improve the evidence-based care and outcomes of cardiac surgical patients worldwide.

[Indexed for MEDLINE]

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