P-07 Incidence, prophylaxis and treatment of postoperative atrial fibrillation following cardiac surgery: a survey from the European Workgroup of Cardiothoracic Intensivists (EWCI)

Abstract

Introduction. Postoperative atrial fibrillation (POAF) is still a major complication following cardiac surgery. It is responsible for an increased risk of stroke, mortality, ICU and hospital stay, and costs. Guidelines for POAF prophylaxis have been presented by several Cardiothoracic Surgical Societies [1]. A survey is presented on the incidence, prophylaxis and treatment of POAF in EWCI centres. Method. A questionnaire was presented to 27 cardiac surgical centres who are represented in the EWCI. The questions were: what is your incidence of POAF, what do you use as prophylaxis and how do you treat it. The questions were aimed at coronary bypass surgery (CABG) and aortic valve replacement (AVR). Results. Twelve centres responded (44%). The incidence of POAF varied between 14.5% and 34% in CABG and between 18% and 38% in AVR. All centres routinely continue preopera-tive beta-blockade and statin therapy postoperatively in CABG, and just statins in AVR. Only one centre started prophylactic therapy with amiodarone postoperatively in CABG. Its use is not mentioned in AVR. Bi-atrial pacing was applied routinely in one centre. For treatment of POAF, amiodarone is given routinely, sometimes in combination with digoxin. Occasionally sotalol is used instead of amiodarone. Discussion. The findings show that in most of the EWCI centres the incidence of POAF continues to be high. Specific protocols for the prevention of POAF, except for postoperative continuation of preoperative beta-blockers and statins, are not implemented. Most of the comments emphasize the contribution of systemic inflammation to the development of POAF, although the use of corticosteroids is never mentioned. Prophylaxis with amiodarone is unpopular, which is in accordance with a recent Canadian survey. This is in conflict with convincing evidence that amiodarone and sotalol prophylaxis are effective in reducing PAOF and its complications in CABG [2].