1. Shi, Xiaoming RN

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Postoperative atrial fibrillation (POAF) is the complication most commonly associated with increased mortality after coronary artery bypass grafting (CABG).1,2 POAF usually occurs in the first 2 to 4 days after surgery and rarely after the first postoperative week.3,4 POAF increases the rate of postoperative mortality and leads to complications such as postoperative stroke, hemodynamic compromise, and prolonged length of hospital stay, culminating in an additional $2 billion in care costs.2,5


Beta-blockers are the first line of defense in preventing POAF and atrial flutter following CABG and should be administered for at least 24 hours before CABG to all patients without contraindications to reduce the incidence of POAF complications.1,6 Beta-blocker therapy should also be reinstituted as soon as possible after CABG in all patients without contraindications.6


Without beta-blocker prophylaxis, new-onset POAF is 20% to 40% more likely to occur after CABG and up to 50% more likely after surgical heart valve repair. The incidence of POAF in patients undergoing both CABG and heart valve surgery is as high as 60%.2,7


The leading risk factor for POAF is advanced age. Recent studies show 81.3% of patients who experienced POAF were over age 50.2,3 Other risk factors include comorbidities such as a previous history of atrial fibrillation, chronic obstructive pulmonary disease, previous cardiac surgery, and mitral valve disease.8


Because beta-blockers can cause bradycardia and hypotension, continuous cardiac monitoring and frequent BP measurement are strongly recommended.2 Some antiarrhythmic and antipsychotic drugs can also interact with beta-blockers and cause serious dysrhythmias.9 To avoid orthostatic hypotension, instruct patients to rise from a sitting or supine position slowly, preferably with assistance. Maintaining patent venous access is crucial because patients may require treatment for hypotension or symptomatic bradycardia.




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5. Wu X, Wang C, Zhu J, Zhang C, Zhang Y, Gao Y. Meta-analysis of randomized controlled trials on magnesium in addition to beta-blocker for prevention of postoperative atrial arrhythmias after coronary artery bypass grafting. BMC Cardiovasc Disord. 2013;13:5. [Context Link]


6. Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2011;58(24):e123-e210. [Context Link]


7. Peretto G, Durante A, Limite LR, Cianflone D. Postoperative arrhythmias after cardiac surgery: incidence, risk factors, and therapeutic management. Cardiol Res Pract. 2014;2014:615987. [Context Link]


8. Castella M. Atrial fibrillation and flutter after cardiac surgery. UpToDate. 2014. [Context Link]


9. Kee JL, Hayes ER, McCuistion LE. Cardiovascular agents. In: Pharmacology: A Nursing Process Approach. 7th ed. St. Louis, MO: Elsevier/Saunders; 2012. [Context Link]