2014 AATS guidelines for the prevention and management of perioperative atrial fibrillation and flutter for thoracic surgical procedures. Executive summary

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2014 AATS guidelines for the prevention and management of perioperative atrial fibrillation and flutter for thoracic surgical procedures. Executive summary Gyorgy Frendl, MD, PhD, Alissa C. Sodickson, MD, Mina K. Chung, MD, Albert L. Waldo, MD, PhD, Bernard J. Gersh, MB, ChB, DPhi, James E. Tisdale, PharmD, Hugh Calkins, MD, Sary Aranki, MD, Tsuyoshi Kaneko, MD, Stephen Cassivi, MD, Sidney C. Smith, MD, Dawood Darbar, MD, Jon O. Wee, MD, Thomas K. Waddell, MD, MSc, PhD, David Amar, MD, Dale Adler, MD The Journal of Thoracic and Cardiovascular Surgery Volume 148, Issue 3, Pages 772-791 (September 2014) DOI: 10.1016/j.jtcvs.2014.06.037 Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Prevention strategies and their efficacy for postoperative atrial fibrillation (POAF). LOE, Level of evidence; PVI, pulmonary vein isolation; i.v., intravenous; LVEF, left ventricular ejection fraction; AF, atrial fibrillation. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 772-791DOI: (10.1016/j.jtcvs.2014.06.037) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Management algorithm for postoperative atrial fibrillation (POAF). AF, Atrial fibrillation; MI, myocardial infarction; HF, heart failure; WPW, Wolff-Parkinson-White syndrome; DC, direct current; i.v./IV, intravenous; HR, heart rate; LV, left ventricular; COPD, chronic obstructive pulmonary disease; LA/LAA, left atrial/left atrial appendage; TEE, transesophageal echocardiography. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 772-791DOI: (10.1016/j.jtcvs.2014.06.037) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Management of the hemodynamically unstable patient with new-onset postoperative atrial fibrillation (POAF). AF, Atrial fibrillation; MI, myocardial infarction; HF, heart failure; DC, direct current; i.v., intravenous; TEE, transesophageal echocardiography. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 772-791DOI: (10.1016/j.jtcvs.2014.06.037) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Management of the hemodynamically stable patient with new-onset postoperative atrial fibrillation (POAF) of less than 48 hours duration. WPW, Wolff-Parkinson-White syndrome; HR, heart rate; i.v., intravenous; HF, heart failure; LV, left ventricular; COPD, chronic obstructive pulmonary disease; AF, atrial fibrillation; DC, direct current; TEE, transesophageal echocardiography. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 772-791DOI: (10.1016/j.jtcvs.2014.06.037) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Management of the hemodynamically stable patient with new-onset postoperative atrial fibrillation (POAF) of more than 48 hours duration. WPW, Wolff-Parkinson-White syndrome; HR, heart rate; i.v., intravenous; HF, heart failure; LV, left ventricular; COPD, chronic obstructive pulmonary disease; TEE, transesophageal echocardiography; LA/LAA, left atrial/left atrial appendage; DC, direct current; AF, atrial fibrillation. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 772-791DOI: (10.1016/j.jtcvs.2014.06.037) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 A, Antiarrhythmic drugs recommended for pharmacologic cardioversion of postoperative atrial fibrillation (POAF). B, Antiarrhythmic drugs recommended for maintenance of sinus rhythm after cardioversion of POAF. MI, Myocardial infarction; CAD, coronary artery disease; LV, left ventricular; AV, atrioventricular; CHF, congestive heart failure; HF, heart failure. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 772-791DOI: (10.1016/j.jtcvs.2014.06.037) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 7 Algorithm for the management of patients with preoperative atrial fibrillation (AF). Preop, Preoperative; CHF, congestive heart failure; SOB, shortness of breath; EF, ejection fraction. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 772-791DOI: (10.1016/j.jtcvs.2014.06.037) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 8 Management of anticoagulation for postoperative atrial fibrillation (POAF) lasting longer than 48 hours. NOACs, New oral anticoagulants; INR, international normalized ratio. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 772-791DOI: (10.1016/j.jtcvs.2014.06.037) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 9 Considerations for the management of anticoagulation within the first 48 hours of postoperative atrial fibrillation (POAF). The Journal of Thoracic and Cardiovascular Surgery 2014 148, 772-791DOI: (10.1016/j.jtcvs.2014.06.037) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 10 Stroke risk stratification in atrial fibrillation. From: Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest. 2010;137:263-72. HTN, Hypertension; MI, myocardial infarction; PAD, peripheral arterial disease. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 772-791DOI: (10.1016/j.jtcvs.2014.06.037) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 11 Recommendation for the postdischarge follow-up for patient with new-onset postoperative atrial fibrillation (POAF). Post-op, Postoperative; EF, ejection fraction; NSR, normal sinus rhythm; ECG, electrocardiography. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 772-791DOI: (10.1016/j.jtcvs.2014.06.037) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Online Data Supplement E1 Members of the task force and their affiliation. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 772-791DOI: (10.1016/j.jtcvs.2014.06.037) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions