Atrial Fibrillation After Surgery (POAF)

Two reports published by the US National Library of medicine, National Institutes of Health about post operative atrial fibrillation reveal significantly increased mortality, hospital readmission, and hospital costs.  Atrial fibrillation after surgery is also called POAF or post-operative atrial fibrillation. Whichever term is used for this heart’s arrhythmia, it all boils down to needing to know the facts about it to live with it.

As I’ve explained in my other blog posts, we all have our special interests in life. One of mine is being fascinated about the human body and specifically the incredible living pump called the heart.

The human heart is a highly sophisticated organ here to keep you living well. When things get out of whack, the heart can start to beat irregularly. One such trigger that causes atrial fibrillation is undergoing surgery. The most common culprit is a heart surgery, but even non heart surgeries, such as an orthopedic surgery can trigger episodes of atrial fibrillation.

The results of a study done about POAF reveals that post-operative atrial fibrillation to be the most common complication following cardiac surgery. The incidence of atrial fibrillation developing varies according to patient characteristics such as age, the type of heart disease and for other reasons, too. Also, different types of surgery performed may or may not cause atrial fibrillation after surgery.

How commonly does POAF occur in these types of patients? Depending upon the research studies you consult, it may be between 10-65%. That’s an alarmingly high number of patients. Unfortunately there has been no consistent guideline about how to prevent post operative atrial fibrillation.

Medical professionals wonder why this is happening. Medical records of 49,264 patients having undergone cardiac operations from 2001 to 2012 were reviewed to study this phenomenon.

The mean patient age studied was 64±11 years. The rate of POAF was highest among those undergoing aortic valve replacement plus coronary artery bypass grafting, aortic valve, and mitral valve replacement operations.

More research needs to be done to put in place effective protocols to reduce the incidence of POAF. Remedies for combatting this phenomenon continue to be of great interest among medical professionals assigned to care for these patients.

New Evidence-Based Guidelines to Prevent and Treat Atrial Fibrillation After Surgery

The American Association for Thoracic Surgery (AATS) released new evidence-based guidelines intended to prevent and treat POAF and AFib for thoracic surgical procedures. They published their guidelines in The Journal of Thoracic and Cardiovascular Surgery.

Basically, they recommend…

  • Those at risk for POAF should be continuously monitored telemetrically after surgery for 48 to 72 hours.

  • Patients taking beta-blockers before thoracic surgery should continue to take them.

  • In some cases, intravenous magnesium supplementation may be something useful to prevent POAF.

  • Digoxin should not be used to prevent POAF.

  • For patients who have no previous history of AFib, catheter or surgical pulmonary vein isolation (at the time of surgery) is not recommended to prevent POAF.

  • For patients at increased risk for developing POAF, they might be candidates for taking some medications (diltiazem or amiodarone) as a POAF preventive measure.

Obviously, more research needs to be done in the area of preventing atrial fibrillation after surgery. Being educated is key to know how to work with your atrial fibrillation. Unfortunately, developing post operative atrial fibrillation increases your risk to develop further episodes of atrial fibrillation later in life, even after you recover from your surgery.

Looking for an easy-to-talk-to heart specialist in Houston, TX? Make an appointment with me, Dr. Morales by calling281.446.3645. I do understand how frightening having AFib is. I would be happy to answer any questions you might have to educate your family about this disease.

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