Page 49 - Read Online

Pardo et al. Vessel Plus 2022;6:36 https://dx.doi.org/10.20517/2574-1209.2021.120 Page 15 of 20

Amiodarone, sotalol, flecainide, propafenone, or * 1
dofetilide can be useful to maintain sinus rhythm
When chemical cardioversion is employed in the * 1
setting of continuous or recurrent POAF, the
most reasonable initial drugs are IV followed by
oral amiodarone or oral flecainide
Class Flecainide or propafenone may be considered for * 1
IIb pharmacologic cardioversion of POAF if the pt
has had no previous history of MI, CAD, LV
dysfunction, LV hypertrophy, or valvular disease
considered moderate or greater
IV ibutilide or procainamide may be considered * 1
in pts w/ structural heart disease w/o
hypotension or congestive HF
IV ibutilide or procainamide may be considered * 1
for pts w/ an accessory pathway
Class Amiodarone is not recommended in pts who are * 1
III mechanically ventilated, who have undergone
pneumonectomy, or who have substantial pre-
existing lung disease
Flecainide should not be used in pts with any * * 2
history of structural cardiac disease, including
ventricular hypertrophy, systolic dysfunction, or
any valve or coronary disease
Dronedarone should not be used for the * 1
treatment of POAF in pts w/ HF
13 29 9 6 0 2 0 5

POAF management guidelines between different societies with “*” designating inclusion of criteria. Rows and columns are tallied up. Guidelines
are broken down by the subpopulation and then by the class, each recommendation falls under [8,10,11,89-91] . 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; HF: heart failure; MI:
POAF management guidelines between different societies with; CAD: Coronary artery disease; LV: Left ventricle; CCB: Calcium channel blocker;
NOACs: Novel oral anticoagulants (e.g., direct thrombin inhibitors and anti-Factor Xa agents).

Based on the results found on POAF variability, we propose the following loose definition to be used as a
placeholder until future evidence-based definitions are discovered. This definition is based on consensus
from independent publications and professional societies: new-onset AF should be defined based on ECG
findings longer than 30 s. Treatment or symptoms are confirmatory but do not provide adequate evidence
of clinical new-onset AF.

It is also crucial to arrive at such a conclusion to use our current surgical databases to their highest potential.
Currently, STS has the world’s gold standard clinical outcomes registry in adult cardiac surgery. Since its
inception, more than 100 publications have utilized its information, and it currently contains more than
6.5 million cardiac surgery procedure records [6,17] .

At this time, AATS is creating a new cardiac surgery database which may likely soon achieve the same STS
level of importance to the scientific community . This highlights how crucial it is that the data physicians’
[18]
daily input be of the highest quality and the greatest consistency. As the scientific community works to find
the true impact that POAF has on patients, it must use data that is consistent and based upon clinical
significance.

In summary, POAF has not been consistently defined by all professional societies as an important post-
procedural complication. Instead of being classified uniformly as major morbidity, POAF is frequently
considered a surgical nuisance; however, it should be viewed as a serious morbid complication that can lead