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Pardo et al. Vessel Plus 2022;6:36 https://dx.doi.org/10.20517/2574-1209.2021.120 Page 9 of 20

Table 5. POAF prevention guideline characteristics
ACC
Subpopulation - subcomponents STS AATS AHA & ACS SCAI ACCP HFSA ESC Count
ESC
All Class I Avoid B-blocker withdrawal * * 2
patients Treat pts undergoing cardiac surgery with prophylactic * * 2
oral B-Blocker
Class Diltiazem is reasonable in most patients undergoing * 1
IIa major pulmonary resection who are not on B-blocker
already
Administer amiodarone prophylactically to cardiac * * * 3
surgery
Class Treat pts undergoing cardiac surgery with prophylactic * 1
IIb oral B-Blocker
Magnesium supplementation when Mg low or * * 2
suspected body Mg low
Class Digoxin is not recommended for prophylaxis * 1
III
Amiodarone is not recommended for patients * 1
undergoing pneumonectomy
Flecainide is not recommended for prophylaxis * 1
Digitalis is not recommended for prophylaxis * 1
PVI is not recommended for the prevention of POAF if * 1
no previous AF history
Higher Class I Chronic AF whom it is thought to continue post- * 1
risk operatively, anticoagulation is recommended
Class Administer amiodarone prophylactically to cardiac * 1
IIa surgery
Administer diltiazem prophylactically to POAF pts not * 1
taking B-Blocker
Administer amiodarone prophylactically to pulmonary * 1
resection
Class Administer sotalol prophylactically to cardiac surgery * 1
IIb
Administer IV Amiodarone prophylactically to * 1
esophagectomy
Administration of colchicine may be considered * 1
postoperatively
Administer Atorvastatin prophylactically in higher risk * 1
thoracic surgical procedures
LAA excision during left lung surgery for pts w/ * 1
previous AF History
8 9 5 0 0 1 0 2
POAF prevention guidelines between different societies with “*” designating inclusion of criteria. Rows and columns are tallied up. Guidelines are
broken down by the subpopulation (all patients or higher risk) and then by the class, each recommendation falls under [8,10,91-93] . POAF: Post-
operative atrial fibrillation; STS: Society of Thoracic Surgeons; AATS: American Association for Thoracic Surgery; AHA: American Heart
Association; ACC: American College of Cardiology; HRS: Heart Rhythm Society; ACS: American College of Surgeons; SCAI: Society for
Cardiovascular Angiography and Interventions; ACCP: American College of Chest Physicians; HFSA: Heart Failure Society of America; ESC:
European Society of Cardiology; LAA: POAF prevention guidelines between different societies; PVI: Pulmonary vein isolation.

[15]
Filardo et al. provided a lens into how studies could be conducted to measure if a definition is truly
capturing this data. It used the pre-2014 STS definition, “atrial fibrillation requiring treatment” and
estimated that up to 3.6% of patients post-coronary artery bypass graft every year are not identified to have
clinically relevant POAF . This begs the question if the new STS definition improves upon this estimation
[15]
and also if AATS (by approaching their definition with more “layers”) is less inclusive.