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Page 14 of 20 Pardo et al. Vessel Plus 2022;6:36 https://dx.doi.org/10.20517/2574-1209.2021.120

structural heart disease
Anticoagulation Class For POAF < 48 h, anticoagulation should be * 1
I based on CHA2DS2-VASc risk score for the pt
For POAF > 48 h, antithrombotic medications * 1
are recommended as recommended to non-
surgical pts
Consider anticoagulation if AF > 48 h * 1
Administer antithrombotic medication as * 1
recommended for nonsurgical pts
Class For pts w/ 2+ risk factors w/ POAF > 48 h, * 1
IIa anticoagulation is reasonable if not
contraindicated
For pts w/ < 2 risk factors and not suitable for * 1
warfarin w/ PAOF > 48 h, aspirin (325 mg), is
reasonable if not contraindicated
It is reasonable to administer antithrombotic * 1
medication in pts, as advised for nonsurgical pts
Long term anticoagulation should be considered * 1
for pts at risk for stroke
NOACs (dabigatran, rivaroxaban, apixaban) are * 1
reasonable as an alternative to warfarin for pts
w/o prosthetic heart valve, valve disease, and or
renal impairment or risk of gastrointestinal
bleeding
It is reasonable to continue anticoagulation * 1
therapy for 4 weeks after the return of sinus
rhythm
Class NOACs should be avoided for pts at risk for * 1
III serious bleeding
In high-risk POAF (history of stroke or TIA), * 1
heparin should be considered
Recommended to continue anticoagulation * 1
therapy 30 days after return to sinus rhythm
Rate Class IV of B-blockers or Non-dihydropyridine CCB for * 1
I patients w/ rapid ventricular response
Caution should be used with pts w/ * 1
hypotension, LV dysfunction, or HF
A selective B1-blocking agent is recommended * 1
as the initial drug for rate control in the absence
of moderate-severe chronic obstructive
pulmonary disease or active bronchospasm
Diltiazem should be the first agent used in the * 1
presence of moderate-severe chronic
obstructive pulmonary disease or active
bronchospasm.
Class Combo of AV nodal blocking agents: B-blockers, * 1
IIa non-dihydropyridine CCB, or digoxin can be
useful if single-agent fails
For pts, w/ hypotension, HF, or LV dysfunction * 1
IV amiodarone can be useful
Class For pts, w/ hypotension, HF, or LV dysfunction * 1
IIb IV digoxin can be useful
Class For pts, w/ preexcitation and POAF use of AV * 1
III nodal blocking agents: beta-blockers, IV
amiodarone, non-dihydropyridine CCB, or
digoxin should be avoided
Digoxin as a single agent should not be used for * 1
rate control, although it may be effective in
combination with a B1-blocker or diltiazem.
Rhythm Class IV Amiodarone is useful for pharmacologic * 1
IIa cardioversion of POAF
It is reasonable to restore sinus rhythm * 1
pharmacologically w/ ibutilide or cardioversion