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Pardo et al. Vessel Plus 2022;6:36 https://dx.doi.org/10.20517/2574-1209.2021.120 Page 13 of 20

Table 7. POAF treatments: level of evidence
ACC
Characteristics - subcomponents STS AATS AHA ACS SCAI ACCP HFSA ESC Count
& ESC
All patients Class Reduce or stop catecholaminergic inotropic * 1
I agents
Optimize fluids and maintain normal electrolyte * 1
levels
Evaluate/treat any possible triggering factors * * 2
A non-dihydropyridine CCB is recommended * 1
when beta-blockers are inadequate in achieving
rate control
Maintain Mg > 2 mg/dL * 1
Maintain K > 4 mmol/L * 1
Treat w/ beta-blocker unless contraindicated * 1
Restart home beta-blocker (if applicable) * 1
Check TSH levels * 1
Class Synchronized electrical cardioversion or Ibutilide * 1
IIa as recommended for nonsurgical pts
Hemodynamically Class Synchronized electrical cardioversion within * 1
unstable I 48 h and before anticoagulation
Synchronized electrical cardioversion after 48 h * 1
and w/ anticoagulation continued for 4 weeks
Synchronized electrical cardioversion * * 2
Class If cardioversion is unsuccessful initiate rate and * 1
IIa rhythm control w/ IV esmolol, diltiazem,
digoxin, or amiodarone while preparing repeat
cardioversion
Treat recurrent or refractory POAF through * 1
antiarrhythmic medications as recommended by
pts w/ CAD who develop AF
Should initially manage w/ rate control and * 1
anticoagulation
Class Cardiology consultation may be useful * 1
IIb
Hemodynamically Class Pts w/ hemodynamically stable and * 1
stable I symptomatically acceptable POAF should
receive a rate control lasting approximately 24 h
Pts w/ hemodynamically stable but * 1
symptomatically intolerable AF should be
chemically or electrically cardioverted
Class Manage w/ rate control strategy * * 2
IIa
Pharmacologic or cardioversion is reasonable in * 1
pts who have recurrent or refractory POAF are
uncontrolled v. rates or medication symptoms
Pts w/ hemodynamically stable, continuous, or * 1
recurrent, POAF ongoing > 24 h after initiation
of rate control, it is reasonable to attempt
chemical cardioversion
Pharmacologic or electrical cardioversion is * 1
reasonable in pts who are nearing 48 h new-
onset POAF that have contraindications for
anticoagulation
Antiarrhythmic medication should be * * 2
considered to restore sinus rhythm
Class Pts w/ hemodynamically stable, continuous, or * 1
IIb recurrent, POAF ongoing after chemical
cardioversion may be considered for an
electrical cardioversion
IV Vernakalant may be considered for * 1
cardioversion w/o severe HF, HTN, or severe