Volume : 12, Issue : 08, August- 2025
Title:
LATEST GUIDELINES FOR PREVENTING AND MANAGING ATRIAL FIBRILLATION FOLLOWING CARDIAC SURGERY: A UK PRACTICE SURVEY
Authors :
Ramy Abdallah, Jumanah Alshaikh, Jillan Althubaiti, Alyaa Arab, Sarah Akeel
Abstract :
Introduction: There are differing recommendations from various organizations for preventing post-cardiac surgery POAF. To define “usual care” for a platform trial of intervention to stop and prevent POAF following heart surgery, a survey of UK practice was carried out. All current guidelines for the prevention and management of atrial fibrillation (AF) following cardiac surgery were examined in order to set the scene for the survey. Objectives: About 30% of individuals experience postoperative atrial fibrillation (POAF), the most frequent complication following heart surgery.
Design: Literature review and online survey. The survey was completed by all 35 UK National Health Service Cardiac Surgery Centers. Specialty societies’ and other organizations’ guidelines from North America, Europe, and the United Kingdom were examined. Participants: A link network of researchers was established.
Measurements and Key Findings: The literature review found five pertinent guidelines’-blockade is advised by all guidelines to prevent AF following heart surgery. It is advised to treat AF with either rate or rhythm control. Cardio version is only advised for patients who are thermodynamically unstable. Anticoagulation should be considered for patients who stay in AF for more than 48 hours. Patients should get antiarrhythmic and anticoagulant therapy after being monitored for 60 days.31 (89%) out of 35 centers responded. Eleven out of thirty-one (35.5%) centers followed local guidelines for the prevention of POAF, four (13%), and the Society of Cardiovascular Anesthesiologists/European Association of Cardiothoracic Anesthesia guidelines. Guidance from the UK National Institute of Health and Care Excellence and 4 adhered to “other” guidelines. Eight (26%) of the 31 centers did not follow any protocols to prevent POAF, and 28 (90%) of the 31 centers did not risk-stratify their patients for POAF. The majority of centers (23 out of 31 and 74%), did not have a care package in place to avoid POAF, but 14 out of 31 (45%) tried to prevent AF in patients who presented with sinus rhythm. B-blocker use postoperatively (23/31,74%), magnesium (20/31,64.5%), and maintaining serum K+ ~4.5 mmol/L (26/31,84%) are the most common therapies to prevent POAF.
Conclusions: B-blockade is the mainstay of advice on how to avoid AF following heart surgery. B-blockade and maintaining serum K+ and Mg2+ levels are the two main therapies utilized to avoid POAF, even though people in the UK don’t seem to be at risk for it.
Cite This Article:
Please cite this article in press Ramy Abdallah et al., Latest Guidelines For Preventing And Managing Atrial Fibrillation Following Cardiac Surgery: A Uk Practice Survey., Indo Am. J. P. Sci, 2025; 12(08)..
Number of Downloads : 10
References:
1. NICOR: National adult cardiac surgery audit 2017-20. National Institute of Cardiac Outcomes Research; 2021.
2. NHS England. National Cost Collection 2020-21. Available at: https:// www.england.nhs.uk/costing-in-the-nhs/national-cost-collection/#ncc1819.
3. Mariscalco G, Klersy C, Zanobini M, et al. Atrial fibrillation after isolated coronary surgery affects late survival. Circulation 2008;118:1612–8.
4. Dobrev D, Aguilar M, Heijman J, et al. Postoperative atrial fibrillation: mechanisms, manifestations and management. Nat Rev Cardiol 2019; 16:417–36.
5. Ahlsson A, Fengsrud E, Bodin L, et al. Postoperative atrial fibrillation in patients undergoing aortocoronary bypass surgery carries an eightfold risk of future atrial fibrillation and a doubled cardiovascular mortality. Eur J Cardiothorac Surg 2010;37:1353–9.
6. El-Chami MF, Kilgo P, Thourani V, et al. New-onset atrial fibrillation pre- dicts long-term mortality after coronary artery bypass graft. J Am Coll Car- diol 2010;55:1370–6.
7. Hravnak M, Hoffman LA, Saul MI, et al. Resource utilization related to atrial fibrillation after coronary artery bypass grafting. Am J Crit Care 2002;11:228–38.
8. Lai FY, Abbasciano RG, Tabberer B, et al. Identifying research priorities in cardiac surgery: A report from the James Lind Alliance Priority Setting Partnership in adult heart surgery. BMJ Open 2020;10:e038001.
9. Burrage PS, Low YH, Campbell NG, et al. New-onset atrial fibrillation in adult patients after cardiac surgery. Curr Anesthesiol Rep 2019;9:174–93.
10. National Institute of Health and Care Excellence. NG 196: Atrial fibrilla- tion: Diagnosis and management.
11. O’Brien B, Burrage PS, Ngai JY, et al. Society of Cardiovascular Anes- thesiologists/European Association of Cardiothoracic Anaesthetists prac- tice advisory for the management of perioperative atrial fibrillation in patients undergoing cardiac surgery. J Cardiothorac Vasc Anesth 2019; 33:12–26.
12. UK Health Research Authority Decision Tool. Available at: https://www. hra-decisiontools.org.uk/research/.
13. Gibbison B, Murphy GJ, Akowuah E, et al. Pre-operative and prehabilita- tion services in UK cardiac surgery centres. Anaesthesia 2023;78:388–91.
14. Gibbison B, EC de Cothi. Care pathways to prevent, identify, and treat delirium in United Kingdom cardiac surgery centers. J Cardiothorac Vasc Anesth 2024;38:348–9.
15. Andrade JG, Aguilar M, Atzema C, et al. The 2020 Canadian Cardiovascu- lar Society/Canadian Heart Rhythm Society comprehensive guidelines for the management of atrial fibrillation. Can J Cardiol 2020;36:1847–948.
16. Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/ HRS guideline for the diagnosis and management of atrial fibrillation: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circula- tion 2024;83:109–279.
17. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC guidelines for the diag- nosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the Diagnosis and Management of Atrial Fibrillation of the European Society of Cardiology (ESC) Developed with the special contri- bution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021;42:373–498.
18. Fleet H, Pilcher D, Bellomo R, et al. Predicting atrial fibrillation after car- diac surgery: A scoping review of associated factors and systematic review of existing prediction models. Perfusion 2023;38:92–108.
19. D’Agostino RS, Jacobs JP, Badhwar V, et al. The Society of Thoracic Sur- geons Adult Cardiac Surgery Database: 2018 Update on outcomes and quality. Ann Thorac Surg 2018;105:15–23.
20. Blessberger H, Lewis SR, Pritchard MW, et al. Perioperative beta- blockers for preventing surgery-related mortality and morbidity in adults undergoing non-cardiac surgery. Cochrane Database Syst Rev 2019;9: CD013438.
21. White KC, Laupland KB, Bellomo R, et al. Trials and the importance of usual care. Crit Care 2024;28:223.
22. Campbell NG, Allen E, Sanders J, et al. The impact of maintaining serum potassium ≥3.6 mEq/L vs ≥4.5 mEq/L on the incidence of new-onset atrial fibrillation in the first 120 hours after isolated elective coronary artery bypass grafting—Study protocol for a randomised feasibility trial for the proposed Tight K randomized non-inferiority trial. Trials 2017;18:618.
23. Wennberg JE. Unwarranted variations in healthcare delivery: Implications for academic medical centres. BMJ 2002;325:961–4.