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Higgs M, McDonagh J, Sim J. Clinical practices for defining, detecting, and diagnosing postoperative atrial fibrillation after coronary revascularization surgery - A scoping review. Aust Crit Care 2024:S1036-7314(24)00119-X. [PMID: 39060153 DOI: 10.1016/j.aucc.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 04/24/2024] [Accepted: 06/11/2024] [Indexed: 07/28/2024] Open
Abstract
OBJECTIVES This scoping review was undertaken to understand the degree of variation in clinical practices associated with postoperative atrial fibrillation (POAF), following coronary revascularization surgery by collating and synthesising key concepts from current published literature. REVIEW METHODS AND DATA SOURCES This scoping review was conducted following the framework outlined by Askey and O'Malley. Reporting of this scoping review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Initial searches were completed in September 2020 and updated in January 2023. Comprehensive searches to identify relevant published literature were carried out within CINAHL, MEDLINE, and ProQuest databases. All searches were limited to full-text papers published in English with human adult participants. Deductive content analysis using NVivo software was performed to synthesise the data. RESULTS A total of 692 studies were identified during the database searches. After the deletion of duplicates and the application of the inclusion and exclusion criteria, 73 studies were included in the scoping review. The included studies were published between 2001 and 2022 and included a total of 24,833 participants. Forty-six studies included a definition of POAF, with four of these citing a peak-body definition. A total of 24 included studies reported on electrocardiogram diagnostic criteria for POAF, with 13/24 [54%] describing these characteristics within their definition. The time-based diagnostic criteria ranged from a minimum duration of greater than 30 seconds to greater than 1 hour. The most frequently reported minimum-time thresholds were ≥30 seconds, reported in 12 of 51 (24%) studies and ≥5 min, reported in 13 of 51 (25%) studies. CONCLUSIONS There is a lack of consistency in clinical practice for defining, detecting, and diagnosing POAF, following coronary revascularization surgery. Consensus and standardisation of clinical practices are urgently needed.
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Affiliation(s)
- Megan Higgs
- Southeastern Sydney Local Health District, New South Wales, Australia
| | - Julee McDonagh
- The Centre for Chronic and Complex Care Research, Blacktown Hospital, Western Sydney Local Health District, New South Wales, Australia; School of Nursing, Faculty of Science, Medicine and Health, The University of Wollongong, New South Wales, Australia.
| | - Jenny Sim
- School of Nursing, Faculty of Science, Medicine and Health, The University of Wollongong, New South Wales, Australia; School of Nursing, Midwifery & Paramedicine, Australian Catholic University, New South Wales, Australia
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Utility of magnesium sulfate in the treatment of rapid atrial fibrillation in the emergency department: a systematic review and meta-analysis. Eur J Emerg Med 2022; 29:253-261. [PMID: 35503562 DOI: 10.1097/mej.0000000000000941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Atrial fibrillation with rapid ventricular response (Afib/RVR) is a frequent reason for emergency department (ED) visits and can be treated with a variety of pharmacological agents. Magnesium sulfate has been used to prevent and treat postoperative Afib/RVR. We performed a systematic review and meta-analysis to assess the effectiveness of magnesium for treatment of Afib/RVR in the ED. PubMed and Scopus databases were searched up to June 2021 to identify any relevant randomized trials or observational studies. We used Cochrane's Risk-of-Bias tools to assess study qualities and random-effects meta-analysis for the difference of heart rate (HR) before and after treatment. Our search identified 395 studies; after reviewing 11 full texts, we included five randomized trials in our analysis. There were 815 patients with Afib/RVR; 487 patients (60%) received magnesium treatment, whereas 328 (40%) patients received control treatment. Magnesium treatment was associated with significant reduction in HR [standardized mean difference (SMD), 0.34; 95% CI, 0.21-0.47; P < 0.001; I2 = 4%), but not associated with higher rates of sinus conversion (OR, 1.46; 95% CI, 0.726-2.94; P = 0.29), nor higher rates of hypotension and bradycardia (OR, 2.2; 95% CI, 0.62-8.09; P = 0.22). Meta-regressions demonstrated that higher maintenance dose (corr. coeff, 0.17; P = 0.01) was positively correlated with HR reductions, respectively. We observed that magnesium infusion can be an effective rate control treatment for patients who presented to the ED with Afib/RVR. Further studies with more standardized forms of control and magnesium dosages are necessary to assess the benefit/risk ratio of magnesium treatment, besides to confirm our observations.
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Abstract
Sotalol is effective for treating atrial fibrillation (AF), ventricular tachycardia, premature ventricular contractions, and supraventricular tachycardia. Racemic (DL) sotalol inhibits the rapid component of the delayed rectifier potassium current. There is a near linear relationship between sotalol dosage and QT interval prolongation. However, in dose ranging trials in patients with AF, low-dose sotalol was not more effective than placebo. Orally administered sotalol has a bioavailability of nearly 100%. The only significant drug interactions are the need to avoid or limit use of concomitant drugs that cause QT prolongation, bradycardia, and/or hypotension.
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Affiliation(s)
- John Alvin Kpaeyeh
- Division of Cardiology, Department of Medicine, Tourville Arrhythmia Center, Medical University of South Carolina, 114 Doughty Street, MSC 592, Charleston, SC 29425-5920, USA
| | - John Marcus Wharton
- Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Tourville Arrhythmia Center, Medical University of South Carolina, 114 Doughty Street, BM 216, MSC 592, Charleston, SC 29425-5920, USA.
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Koniari I, Apostolakis E, Rogkakou C, Baikoussis NG, Dougenis D. Pharmacologic prophylaxis for atrial fibrillation following cardiac surgery: a systematic review. J Cardiothorac Surg 2010; 5:121. [PMID: 21118555 PMCID: PMC3006380 DOI: 10.1186/1749-8090-5-121] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 11/30/2010] [Indexed: 01/22/2023] Open
Abstract
Atrial Fibrillation (AF) is the most common arrhythmia occurring after cardiac surgery. Its incidence varies depending on type of surgery. Postoperative AF may cause hemodynamic deterioration, predispose to stroke and increase mortality. Effective treatment for prophylaxis of postoperative AF is vital as reduces hospitalization and overall morbidity. Beta-blockers, have been proved to prevent effectively atrial fibrillation following cardiac surgery and should be routinely used if there are no contraindications. Sotalol may be more effective than standard b-blockers for the prevention of AF without causing an excess of side effects. Amiodarone is useful when beta-blocker therapy is not possible or as additional prophylaxis in high risk patients. Other agents such as magnesium, calcium channels blocker or non-antiarrhythmic drugs as glycose-insulin--potassium, non-steroidal anti-inflammatory drugs, corticosteroids, N-acetylcysteine and statins have been studied as alternative treatment for postoperative AF prophylaxis.
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Affiliation(s)
- Ioanna Koniari
- Cardiothoracic Surgery Department. Patras University, School of Medicine. Rion Patras, Greece
| | - Efstratios Apostolakis
- Cardiothoracic Surgery Department. Patras University, School of Medicine. Rion Patras, Greece
| | - Christina Rogkakou
- Cardiothoracic Surgery Department. Patras University, School of Medicine. Rion Patras, Greece
| | - Nikolaos G Baikoussis
- Cardiothoracic Surgery Department. Patras University, School of Medicine. Rion Patras, Greece
| | - Dimitrios Dougenis
- Cardiothoracic Surgery Department. Patras University, School of Medicine. Rion Patras, Greece
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Cavolli R, Kaya K, Aslan A, Emiroglu O, Erturk S, Korkmaz O, Oguz M, Tasoz R, Ozyurda U. Does Sodium Nitroprusside Decrease the Incidence of Atrial Fibrillation After Myocardial Revascularization? Circulation 2008; 118:476-81. [DOI: 10.1161/circulationaha.107.719377] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Atrial fibrillation (AF) often occurs after coronary artery bypass grafting and can result in increased morbidity and mortality. In the present pilot study, our aim was to investigate whether sodium nitroprusside (SNP), as a nitric oxide donor, can reduce the frequency of post–coronary artery bypass grafting AF.
Methods and Results—
To investigate the effectiveness of SNP in the prophylaxis of AF, we conducted a prospective, randomized, placebo-controlled clinical study on 100 consecutive patients in whom we performed elective and initial CABG operations. A control group of 50 patients were treated with placebo (dextrose 5% in water), whereas the SNP group (n=50 patients) was treated with SNP (0.5 μg · kg
−1
· min
−1
) during the rewarming period. High-sensitivity C-reactive protein levels were measured before surgery and 5 days postoperatively. All patients were monitored postoperatively with telemetry. Baseline characteristics were similar in both treatment groups. AF occurred in 12% of the SNP group and 27% of the control group. The occurrence of AF was significantly lower in the SNP group (
P
=0.005). The duration of AF in the SNP group was significantly shorter than that in the control group (5.33±1.86 and 7.55±1.94 hours, respectively;
P
=0.023). C-reactive protein levels were higher postoperatively in the control group than in the SNP group (
P
<0.05). Postoperative AF significantly prolonged postoperative hospital stay (
P
<0.05).
Conclusions—
The incidence of postoperative AF in the SNP group was reduced significantly. Further studies are needed to better delineate the anti-AF profile of SNP.
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Affiliation(s)
- Raif Cavolli
- From the Department of Cardiovascular Surgery, Umut Heart Hospital (R.C., K.K., O.E., S.E., M.O.), Ankara, Turkey; Department of Cardiovascular Surgery, Kavaklidere Umut Hospital (A.A., O.K.), Ankara, Turkey; and Department of Cardiovascular Surgery, University of Ankara, School of Medicine (R.T., U.O.), Ankara, Turkey
| | - Kaan Kaya
- From the Department of Cardiovascular Surgery, Umut Heart Hospital (R.C., K.K., O.E., S.E., M.O.), Ankara, Turkey; Department of Cardiovascular Surgery, Kavaklidere Umut Hospital (A.A., O.K.), Ankara, Turkey; and Department of Cardiovascular Surgery, University of Ankara, School of Medicine (R.T., U.O.), Ankara, Turkey
| | - Alp Aslan
- From the Department of Cardiovascular Surgery, Umut Heart Hospital (R.C., K.K., O.E., S.E., M.O.), Ankara, Turkey; Department of Cardiovascular Surgery, Kavaklidere Umut Hospital (A.A., O.K.), Ankara, Turkey; and Department of Cardiovascular Surgery, University of Ankara, School of Medicine (R.T., U.O.), Ankara, Turkey
| | - Ozan Emiroglu
- From the Department of Cardiovascular Surgery, Umut Heart Hospital (R.C., K.K., O.E., S.E., M.O.), Ankara, Turkey; Department of Cardiovascular Surgery, Kavaklidere Umut Hospital (A.A., O.K.), Ankara, Turkey; and Department of Cardiovascular Surgery, University of Ankara, School of Medicine (R.T., U.O.), Ankara, Turkey
| | - Sebnem Erturk
- From the Department of Cardiovascular Surgery, Umut Heart Hospital (R.C., K.K., O.E., S.E., M.O.), Ankara, Turkey; Department of Cardiovascular Surgery, Kavaklidere Umut Hospital (A.A., O.K.), Ankara, Turkey; and Department of Cardiovascular Surgery, University of Ankara, School of Medicine (R.T., U.O.), Ankara, Turkey
| | - Ozge Korkmaz
- From the Department of Cardiovascular Surgery, Umut Heart Hospital (R.C., K.K., O.E., S.E., M.O.), Ankara, Turkey; Department of Cardiovascular Surgery, Kavaklidere Umut Hospital (A.A., O.K.), Ankara, Turkey; and Department of Cardiovascular Surgery, University of Ankara, School of Medicine (R.T., U.O.), Ankara, Turkey
| | - Mehmet Oguz
- From the Department of Cardiovascular Surgery, Umut Heart Hospital (R.C., K.K., O.E., S.E., M.O.), Ankara, Turkey; Department of Cardiovascular Surgery, Kavaklidere Umut Hospital (A.A., O.K.), Ankara, Turkey; and Department of Cardiovascular Surgery, University of Ankara, School of Medicine (R.T., U.O.), Ankara, Turkey
| | - Refik Tasoz
- From the Department of Cardiovascular Surgery, Umut Heart Hospital (R.C., K.K., O.E., S.E., M.O.), Ankara, Turkey; Department of Cardiovascular Surgery, Kavaklidere Umut Hospital (A.A., O.K.), Ankara, Turkey; and Department of Cardiovascular Surgery, University of Ankara, School of Medicine (R.T., U.O.), Ankara, Turkey
| | - Umit Ozyurda
- From the Department of Cardiovascular Surgery, Umut Heart Hospital (R.C., K.K., O.E., S.E., M.O.), Ankara, Turkey; Department of Cardiovascular Surgery, Kavaklidere Umut Hospital (A.A., O.K.), Ankara, Turkey; and Department of Cardiovascular Surgery, University of Ankara, School of Medicine (R.T., U.O.), Ankara, Turkey
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Chryssagis K, Klügl S, Liangos A, Gutleben KJ, Brachmann J, Diegeler A. Surgical Feasibility of the Injection of Fibrin Sealant in Cardiac Fat Pads to Reduce the Incidence of Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting or Valve Surgery: A Pilot Study. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2008. [DOI: 10.1177/155698450800300308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Stefan Klügl
- Department of Cardiovascular Surgery, Rhoen Klinikum, Bad Neustadt
| | - Aris Liangos
- Department of Cardiovascular Surgery, Rhoen Klinikum, Bad Neustadt
| | | | | | - Anno Diegeler
- Department of Cardiovascular Surgery, Rhoen Klinikum, Bad Neustadt
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