ABSTRACT
Atrial fibrillation is one of the most common complications after cardiac surgery and is associated with adverse outcomes such as increased mortality, neurological problems, longer hospitalizations, and increased cost of care. Major risk factors for the development of postoperative atrial fibrillation include older age and a history of atrial fibrillation. beta-Blockers are the most effective preventive therapy, although sotalol and amiodarone can also be used for prophylaxis. In the postoperative period, the nurse plays an important role in the early detection of atrial fibrillation by the recording of an atrial electrogram, which is easily obtained from the bedside monitor. Because an atrial electrogram records larger atrial activity than ventricular activity, it can be invaluable in establishing the diagnosis of postoperative atrial fibrillation. Once atrial fibrillation begins, treatment can be started with either rhythm conversion or rate-controlling medications.
Subject(s)
Atrial Fibrillation/diagnosis , Cardiac Surgical Procedures/adverse effects , Critical Care/methods , Electrocardiography/methods , Monitoring, Physiologic/methods , Postoperative Care/methods , Anti-Arrhythmia Agents/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Atrial Fibrillation/epidemiology , Atrial Fibrillation/etiology , Cost of Illness , Early Diagnosis , Electrocardiography/nursing , Hospital Mortality , Humans , Incidence , Length of Stay , Monitoring, Physiologic/nursing , Nurse's Role , Nursing Assessment , Outcome Assessment, Health Care , Point-of-Care Systems , Postoperative Care/psychology , Preoperative Care/methods , Preoperative Care/nursing , Risk Assessment , Risk FactorsABSTRACT
Postoperative atrial fibrillation (POAF) is the most common and vexing complication of cardiac surgeries in adults. The consequences of this dysrhythmia are numerous and include hemodynamic instability, increased risk for embolic stroke, increased length of hospital stay, increased cost of hospitalization, significant resource utilization, and decreased long-term survival. While some progress has been made in prevention of POAF, the multiple mechanisms involved in its genesis are yet to be elucidated. This article reviews our current understanding of these mechanisms, predictors of POAF, drug therapy for prevention and treatment, and new uses for pacing and internal cardioversion for the prevention and treatment of POAF.
