Selim listed factors associated with postoperative atrial fibrillation following cardiac surgery. This may occur in up to half of these patients, usually with an onset 2 to 4 days after surgery.

Nonmodifiable factors:

(1) advanced age (will use age >= 60 years)

(2) history of preoperative atrial fibrillation

(3) history of supraventricular tachycardia

(4) history of myocardial infarction affecting the inferior wall

(5) heart failure or low left ventricular ejection fraction prior to surgery


Type of operation:

(1) coronary artery bypass graft (CABG) surgery plus valve replacement (aortic, other)


Modifiable factors:

(1) withdrawal of angiotensin-converting enzyme (ACE) inhibitor therapy in the perioperative period

(2) withdrawal of beta blocker therapy in the perioperative period

(3) elevated magnesium level following surgery

(4) other acute electrolyte or fluid imbalances in the postoperative period


The risk of postoperative atrial fibrillation can be reduced by:

(1) therapy with amiodarone and a beta-blocker, starting 5 days prior to the surgery.

(2) continuation of rate-controlling or antiarrhythmic drugs during and after surgery in patients with a history of atrial fibrillation

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