Management of Perioperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery

Perioperative oral β-blocker therapy is recommended for the prevention of postoperative AF after cardiac surgery.

A nondihydropyridine calcium channel blocker or β-blocker is recommended to achieve rate control with postoperative AF.

Restoration of sinus rhythm by electrical cardioversion or antiarrhythmic drugs is recommended in postoperative AF with hemodynamic instability.

Perioperative amiodarone should be considered to prevent AF after cardiac surgery.

Asymptomatic postoperative AF should initially be managed with rate control and anticoagulation.

Long-term anticoagulation should be considered in patients with postoperative AF, considering individual stroke and bleeding risk.

Antiarrhythmic drugs or direct current cardioversion should be considered for symptomatic postoperative AF after cardiac surgery in an attempt to restore sinus rhythm.

Intravenous vernakalant may be considered for cardioversion of postoperative AF in patients without severe heart failure, hypotension, or severe structural heart disease (especially aortic stenosis).

Colchicine may be considered postoperatively to reduce AF after cardiac surgery.

Statin use prevents postoperative AF but is equivocal.

Digoxin does not reduce postoperative AF.