Several chapters in this clinical practice guideline address issues related to pharmacologic interventions in the management of postoperative atrial fibrillation or atrial flutter. The article on pharmacologic prophylaxis focused on Vaughan-Williams class I, II, and III agents, as well as on other strategies such as the use of digitalis, insulin, alinidine, and dexamethasone (Table 5
). The analysis of the data demonstrated the variability in the efficacy of many of these agents in preventing postoperative atrial fibrillation or atrial flutter. A relatively strong recommendation was made for the use of beta-blockers (class II) in patients in whom prophylaxis is indicated. Although therapy with sotalol can be considered, the drug is associated with increased toxicity and, therefore, may not be the optimal preventive strategy.