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Ann Thorac Surg 2001;72:697-698
© 2001 The Society of Thoracic Surgeons

Invited commentary

^a Louisiana State University Health Sciences Center, 1542 Tulane Ave, 7th Floor, New Orleans, LA 70112-2822, USA

e-mail: tbruceferg732{at}pol.net

This article by Soucier and colleagues helps to bring the jigsaw puzzle of postoperative atrial fibrillation into somewhat clearer focus. From the digoxin versus beta-blocker debates of the 1970s, through the Class I era of the 1980s, through the Class III and newer Classes I and III drugs of the 1990s, we now appear to be coming full circle, with further evidence that rate control alone is associated with a significant rate of stable conversion to sinus rhythm. This suggests that in many cases "minimalist treatment" may be sufficient for this most bothersome of postoperative complications.

The puzzle is not complete, however, and this study adds several important pieces. First, the study population of 163 patients with postoperative atrial fibrillation (AF) consisted of both coronary artery bypass grafting (CABG) and valve patients; in contrast to many previous studies that have focused on CABG patients only. Secondly, patients with a history of paroxysmal AF, diabetes, and significantly impaired EF are at increased risk for postop AF according to this study. These higher-risk subsets may warrant more aggressive therapy, either as treatment for AF upon its occurrence or as specifically-designed therapy to prophylax against the occurrence of AF. Most importantly, perhaps, the study offers additional evidence for beta-blockade therapy early postoperatively, not only to prophylax against AF, but also to increase the conversion rate to sinus rhythm when AF does occur. Coupled with recent evidence documenting that preoperative beta-blockade conveys a substantial survival advantage in patients undergoing CABG [1], these data suggest that cardiothoracic surgeons should examine the use of this class of drugs in all components of cardiovascular surgical care.

Finally, the authors excluded from this retrospective analysis a subset of 190 patients who received, at the discretion of the surgeon or cardiologist, Class I or III anti-arrhythmic therapy within 24 hours of the onset of postop AF. We can hopefully anticipate a subsequent analysis of this subset by these authors, and a comparison of the populations, indications and success of this approach as compared to the "minimalist" form of therapy for postop AF suggested by this present analysis.

References

1. Ferguson T.B., Jr, Coombs L.P., Peterson E.D. The STS National Database and the DCRI: perioperative Beta-adrenergic blockade in CABG: Use and Effectiveness. Circulation 2000;102(Suppl II):II583.

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 Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ferguson, T. B. Search for Related Content PubMed Articles by Ferguson, T. B., Jr Related Collections Electrophysiology - arrhythmias Related Article