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Original Articles: Adult Cardiac

Invited Commentary

University of Minnesota, Minneapolis, MN 55455

(Email: joyce033{at}umn.edu).

I read with interest the article by Price and colleagues [1].

Perioperative atrial fibrillation following cardiac surgery is perhaps the most annoying complication that a surgeon deals with. While it is commonly perceived as a minor problem compared to the overall list of possible adverse events, it does delay the patient's recovery, requires additional interventions or medication with possible side effects, prolongs hospitalization, and can result in major complications such as stroke or death. The lack of clear understanding of the etiology of atrial fibrillation in this setting most certainly impacts a surgeon's willingness to accept various types of proposed prophylactic treatment. If the mechanism of action of a prophylactic agent clearly interrupted a known cause/effect pathway, it may be more readily adopted.

The literature is laden with articles claiming success in treating this problem, only to be proven ineffective in subsequent clinical series. Consequently, there may be an inborn distrust of any new "gimmick" and an assumption that "this fad too will pass". Amiodarone, beta-blockers, and to a lesser degree corticosteroids have been studied in multiple settings with enough success that at least takes them out of the "fad" category. Perhaps it is time that we surgeons pay closer attention to well controlled studies and attempt to seriously consider a prophylactic treatment that can have an impact on our practices. This is particularly important when one considers not only the added morbidity, but the added cost that this entity places on our health care system.

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1. Price J, Tee R, Lam B-K, Hendry P, Green MS, Rubens FD. Current use of prophylactic strategies for postoperative atrial fibrillation: a survey of Canadian cardiac surgeons Ann Thorac Surg 2009;88:106-111.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Lyle Joyce Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Joyce, L. Search for Related Content PubMed PubMed Citation Articles by Joyce, L. Related Collections Electrophysiology - arrhythmias Related Article