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General Thoracic and Cardiovascular Surgery

Published in:

01-08-2021 | Stroke | Original Article

Variation in management of post-operative atrial fibrillation (POAF) after thoracic surgery

Authors: Heidi Oi-Yee Li, Heather A. Smith, Olivier Brandts-Longtin, Donna E. Maziak, Sebastien Gilbert, Paul Villeneuve, Sudhir Sundaresan, Andrew J. E. Seely

Published in: General Thoracic and Cardiovascular Surgery | Issue 8/2021

Abstract

Objectives

New-onset post-operative atrial fibrillation (POAF) is a frequent adverse event following major thoracic surgery and is associated with increased risk of perioperative morbidity, length of stay and stroke. It is managed initially with rate and rhythm control therapy; however, optimal duration and the need for anticoagulation are poorly understood. This study aims to assess practice variation regarding POAF management and duration.

Methods

This retrospective, single-center cohort study included patients who underwent major thoracic surgery and developed POAF between 2008 and 2017, managed with rate and rhythm control therapy alone. Demographic, clinical, and surgical variables/outcomes, POAF management, and incidence of POAF recurrence in the 30-day post-operative period were collected. Chi-square and T-tests determined significance.

Results

Of 2054 patients undergoing thoracic surgery, 155 (75%) patients developed POAF. Different rate and rhythm control agents were used, most commonly metoprolol. 107 (69%) continued rate and rhythm control therapy upon hospital discharge for a mean of 56 days. Among the 48 patients with discontinuation of rate and rhythm control therapy on discharge, none demonstrated recurrence of POAF; in contrast to 3 of 107 patients who continued on therapy. Among patients with CHA₂DS₂-VASc score ≥ 2, 15% were prescribed anticoagulation on discharge.

Conclusions

Use of rate and rhythm control therapy and anticoagulation for POAF is significantly varied in practice. Many patients are not continued on rate and rhythm control after hospital discharge, which does not appear to impact risk of POAF recurrence. Further research to inform guidelines for POAF management, including therapy duration and indications for anticoagulation is warranted.

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Title: Variation in management of post-operative atrial fibrillation (POAF) after thoracic surgery
Authors: Heidi Oi-Yee Li
Heather A. Smith
Olivier Brandts-Longtin
Donna E. Maziak
Sebastien Gilbert
Paul Villeneuve
Sudhir Sundaresan
Andrew J. E. Seely
Publication date: 01-08-2021
Publisher: Springer Singapore
Keywords: Stroke
Heart Surgery
Heart Surgery
Atrial Fibrillation
Published in: General Thoracic and Cardiovascular Surgery / Issue 8/2021
Print ISSN: 1863-6705
Electronic ISSN: 1863-6713
DOI: https://doi.org/10.1007/s11748-020-01574-1

At a glance: The STEP trials

Springer Medicine

Variation in management of post-operative atrial fibrillation (POAF) after thoracic surgery

Abstract

Objectives

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

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