ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation* recommend : ...
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Transcript of ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation* recommend : ...
![Page 1: ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation* recommend : Oral B Blockers to prevent post operative atrial.](https://reader037.fdocuments.us/reader037/viewer/2022110206/56649cef5503460f949bcfc6/html5/thumbnails/1.jpg)
Atrial Fibrillation after Cardiac Surgery
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Atrial Fibrillation after Cardiac Surgery
ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation* recommend:
Oral B Blockers to prevent post operative atrial fibrillation. (IA)
Preoperative Amiodarone for high risk patients for AF. (IIa A)
*Circulation. 2006 Aug 15;114(7):e257-354.
![Page 3: ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation* recommend : Oral B Blockers to prevent post operative atrial.](https://reader037.fdocuments.us/reader037/viewer/2022110206/56649cef5503460f949bcfc6/html5/thumbnails/3.jpg)
Atrial Fibrillation after Cardiac Surgery
The goal was to search the literature for data combining postoperative B blockers and intravenous Amiodarone for atrial fibrillation prophylaxis.
![Page 4: ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation* recommend : Oral B Blockers to prevent post operative atrial.](https://reader037.fdocuments.us/reader037/viewer/2022110206/56649cef5503460f949bcfc6/html5/thumbnails/4.jpg)
Atrial Fibrillation after Cardiac Surgery
Included 220 patients. Stratified for valvular surgery.
Patients had to be 60 years or older. Admitted at least on day before surgery.
![Page 5: ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation* recommend : Oral B Blockers to prevent post operative atrial.](https://reader037.fdocuments.us/reader037/viewer/2022110206/56649cef5503460f949bcfc6/html5/thumbnails/5.jpg)
Atrial Fibrillation after Cardiac Surgery
![Page 6: ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation* recommend : Oral B Blockers to prevent post operative atrial.](https://reader037.fdocuments.us/reader037/viewer/2022110206/56649cef5503460f949bcfc6/html5/thumbnails/6.jpg)
Atrial Fibrillation after Cardiac Surgery
![Page 7: ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation* recommend : Oral B Blockers to prevent post operative atrial.](https://reader037.fdocuments.us/reader037/viewer/2022110206/56649cef5503460f949bcfc6/html5/thumbnails/7.jpg)
Atrial Fibrillation after Cardiac Surgery
![Page 8: ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation* recommend : Oral B Blockers to prevent post operative atrial.](https://reader037.fdocuments.us/reader037/viewer/2022110206/56649cef5503460f949bcfc6/html5/thumbnails/8.jpg)
Atrial Fibrillation after Cardiac Surgery
![Page 9: ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation* recommend : Oral B Blockers to prevent post operative atrial.](https://reader037.fdocuments.us/reader037/viewer/2022110206/56649cef5503460f949bcfc6/html5/thumbnails/9.jpg)
Atrial Fibrillation after Cardiac Surgery
![Page 10: ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation* recommend : Oral B Blockers to prevent post operative atrial.](https://reader037.fdocuments.us/reader037/viewer/2022110206/56649cef5503460f949bcfc6/html5/thumbnails/10.jpg)
Atrial Fibrillation after Cardiac Surgery
Patients admitted between Jan 2001 & May 2002.
Patients with AF, MI within 2 weeks, EF less than 35% and unstable angina were excluded.
Sample size calculation done to detect a 25% difference between treatment groups & placebo.
![Page 11: ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation* recommend : Oral B Blockers to prevent post operative atrial.](https://reader037.fdocuments.us/reader037/viewer/2022110206/56649cef5503460f949bcfc6/html5/thumbnails/11.jpg)
Atrial Fibrillation after Cardiac Surgery
The SPPAF trial 824 patients screened and 512
excluded. Patients were randomized to one of 4
groups. Prophylaxis started 24 to 48 hours
before surgery & continued for 8 days after.
Chronic B blockers were halved (38.3%). Metoprolol 50 mg twice daily with oral
Amiodarone 1200X2, 800X2, 400X5.
![Page 12: ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation* recommend : Oral B Blockers to prevent post operative atrial.](https://reader037.fdocuments.us/reader037/viewer/2022110206/56649cef5503460f949bcfc6/html5/thumbnails/12.jpg)
Atrial Fibrillation after Cardiac Surgery
The SPPAF Trial Results
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Atrial Fibrillation after Cardiac Surgery
The SPPAF Trial Results
![Page 14: ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation* recommend : Oral B Blockers to prevent post operative atrial.](https://reader037.fdocuments.us/reader037/viewer/2022110206/56649cef5503460f949bcfc6/html5/thumbnails/14.jpg)
Atrial Fibrillation after Cardiac Surgery
The SPPAF Trial
![Page 15: ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation* recommend : Oral B Blockers to prevent post operative atrial.](https://reader037.fdocuments.us/reader037/viewer/2022110206/56649cef5503460f949bcfc6/html5/thumbnails/15.jpg)
Atrial Fibrillation after Cardiac Surgery
Patients randomized to receive oral Amiodarone or placebo.
Treatment group received 10 mg/Kg/day of Amiodarone for 6 days preoperatively and 6 days postoperatively.
601 patients were included.
![Page 16: ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation* recommend : Oral B Blockers to prevent post operative atrial.](https://reader037.fdocuments.us/reader037/viewer/2022110206/56649cef5503460f949bcfc6/html5/thumbnails/16.jpg)
Atrial Fibrillation after Cardiac Surgery
![Page 17: ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation* recommend : Oral B Blockers to prevent post operative atrial.](https://reader037.fdocuments.us/reader037/viewer/2022110206/56649cef5503460f949bcfc6/html5/thumbnails/17.jpg)
Atrial Fibrillation after Cardiac Surgery
![Page 18: ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation* recommend : Oral B Blockers to prevent post operative atrial.](https://reader037.fdocuments.us/reader037/viewer/2022110206/56649cef5503460f949bcfc6/html5/thumbnails/18.jpg)
Atrial Fibrillation after Cardiac Surgery
![Page 19: ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation* recommend : Oral B Blockers to prevent post operative atrial.](https://reader037.fdocuments.us/reader037/viewer/2022110206/56649cef5503460f949bcfc6/html5/thumbnails/19.jpg)
Atrial Fibrillation after Cardiac Surgery
Patients randomized to receive Amiodarone or placebo then atrial pacing or not.
Treatment group received 1050 mg Amio IV loading dose over 24h within 6 hours of surgery, followed by 400 mg TID for 4 days.
160 patients were included.
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Atrial Fibrillation after Cardiac Surgery
AFIST II Trial
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Atrial Fibrillation after Cardiac Surgery
AFIST II Trial
![Page 22: ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation* recommend : Oral B Blockers to prevent post operative atrial.](https://reader037.fdocuments.us/reader037/viewer/2022110206/56649cef5503460f949bcfc6/html5/thumbnails/22.jpg)
Atrial Fibrillation after Cardiac Surgery
AFIST II Trial
![Page 23: ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation* recommend : Oral B Blockers to prevent post operative atrial.](https://reader037.fdocuments.us/reader037/viewer/2022110206/56649cef5503460f949bcfc6/html5/thumbnails/23.jpg)
Atrial Fibrillation after Cardiac Surgery
AFIST II Trial
![Page 24: ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation* recommend : Oral B Blockers to prevent post operative atrial.](https://reader037.fdocuments.us/reader037/viewer/2022110206/56649cef5503460f949bcfc6/html5/thumbnails/24.jpg)
Atrial Fibrillation after Cardiac Surgery
Intravenous amiodarone or magnesium sulphate is not cost-beneficial prophylaxis for atrial fibrillation after coronary artery bypass surgery. Br J Anaesth. 2000;85:690-5.
155 patients were included. Randomized to a 72h infusion of 900 mg/day
of Amiodarone, 4 gm of MgSo4 a day, or placebo.
No difference in atrial fibrillation. Higher rate of complications with Amiodarone.
Resulted in stopping it in 4 patients.
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Thank You