Chest ACCP Career Connection
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Guest Access | Sign In via User Name/Password
This Article
Right arrow Full Text Free
Right arrow Full Text (PDF) Free
Right arrow Evidence tables (Pharmacologic Control of Rhythm)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Article Archive
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Martinez, E. A.
Right arrow Articles by Zimetbaum, P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Martinez, E. A.
Right arrow Articles by Zimetbaum, P.
(Chest. 2005;128:48S-55S.)
© 2005 American College of Chest Physicians

Pharmacologic Control of Rhythm*

American College of Chest Physicians Guidelines for the Prevention and Management of Postoperative Atrial Fibrillation After Cardiac Surgery

Elizabeth A. Martinez, MD; Eric B. Bass, MD, MPH and Peter Zimetbaum, MD

* From the Departments of Anesthesia (Dr. Martinez) and Medicine (Dr. Bass), The Johns Hopkins University School of Medicine, Baltimore, MD; and the Department of Medicine (Dr. Zimetbaum), Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA.

Correspondence to: Peter Zimetbaum, MD, Division of Cardiology, Beth Israel Deaconess Medical Center, 1 Deaconess Rd, Boston, MA 02215; e-mail: pzimetba{at}bidmc.harvard.edu

Of the 128 articles evaluated on the overall topic of atrial fibrillation (AF) after cardiac surgery, only 19 studies dealing with pharmacologic heart rhythm control were relevant for inclusion in this analysis, indicating the relative paucity of evidence-based studies addressing this topic. We found limited data on guiding treatment for the rhythm control of AF following cardiac surgery in patients who do not require urgent cardioversion; therefore, the choice of an antiarrhythmic drug needs to be guided by patient characteristics. Based on limited available evidence, amiodarone is recommended for pharmacologic conversion of postoperative AF and AFL in patients with depressed left ventricular function who do not need urgent electrical cardioversion. This recommendation is made largely because of the effectiveness of amiodarone and also because of its relatively favorable side-effects profile. Sotalol and class 1A antiarrhythmic drugs are reasonable choices for patients with coronary artery disease who do not have congestive heart failure. There are currently no definitive data to guide the decision about the duration of antiarrhythmic drug therapy for patients with AF following cardiac surgery. Most protocols continue therapy with the antiarrhythmic drug for 4 to 6 weeks following surgery, but evidence from randomized studies is lacking.

Key Words: antiarrhythmic drug • atrial fibrillation • atrial flutter






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2005 by the American College of Chest Physicians.