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Correspondence |

Are the American College of Chest Physicians Guidelines for the Prevention and Management of Atrial Fibrillation After Cardiac Surgery Already Obsolete? FREE TO VIEW

Joel Dunning, PhD
Author and Funding Information

Affiliations: James Cook University Hospital, Middlesbrough, UK,  Duke University, Durham, NC

Correspondence to: Joel Dunning, PhD, James Cook University Hospital, Department of Cardiothoracic Surgery, Marton Rd, Middlesbrough, TS4 3BW UK; e-mail: joeldunning@doctors.org.uk



Chest. 2006;129(4):1112-1113. doi:10.1378/chest.129.4.1112
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Published online

To the Editor:

We congratulate the American College of Chest Physicians for producing a comprehensive set of guidelines for the management of atrial fibrillation (AF) after cardiac surgery.1 We would echo the findings of the guideline that AF is a common complication and yet treatment and prophylaxis vary considerably among countries and institutions. Therefore, any guideline that sets out to unify treatment is to be congratulated.

We are, however, curious to know the rationale for ending the literature search in December 2001. This in our belief has led to the obsolescence of a number of recommendations made in the guidelines.

There is no recommendation for the administration of magnesium for the prophylaxis of AF, on the basis of 14 articles published up to December 2001. However, we have performed a more recent search and have found 20 articles on this subject and 3 metaanalyses. All three metaanalyses24 now agree that magnesium provides a significant benefit in the reduction of AF.

Sotalol is not recommended as being superior to standard β-blockers for prophylaxis on the basis of eight trials. However, we have identified five additional articles and a metaanalysis,511 and would more strongly recommend therapy with sotalol over that with standard β-blockers on the basis of these additional studies.

We have also found 3 articles in addition to the 10 articles cited in this guideline that are in favor of amiodarone prophylaxis,1214 and we have found 15 articles and a metaanalysis that are relevant to atrial pacing compared to the 9 articles cited in these guidelines.15 We would recommend an update of this valuable guideline in the near future, as this is a fast-moving field as indicated in the final chapter of the American College of Chest Physicians guidelines.

McKeown, PP, Gutterman, D (2005) Executive summary: American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillation after cardiac surgery.Chest128(suppl),1-5
 
Rostron, A, Sanni, A, Dunning, J Does magnesium prophylaxis reduce the incidence of atrial fibrillation following coronary bypass surgery?Interact Cardiovasc Thorac Surg2005;4,52-58. [CrossRef] [PubMed]
 
Miller, S, Crystal, E, Garfinkle, M, et al Effects of magnesium on atrial fibrillation after cardiac surgery: a meta-analysis.Heart2005;91,618-623. [CrossRef] [PubMed]
 
Alghamdi, AA, Al-Radi, OO, Latter, DA Intravenous magnesium for prevention of atrial fibrillation after coronary artery bypass surgery: a systematic review and meta-analysis.J Card Surg2005;20,293-299. [CrossRef] [PubMed]
 
Patel, A, Dunning, J Is sotalol more effective than standard beta-blockers for prophylaxis of atrial fibrillation during cardiac surgery?Interact Cardiovasc Thorac Surg1005;4,147-150
 
Auer, J, Webber, T, Berent, R, et al A comparison between oral antiarrhythmic drugs in the prevention of post operative atrial fibrillation (SPPAF), a randomised placebo controlled trial.Am Heart J2004;147,636-643. [CrossRef] [PubMed]
 
Sanjuan, R, Blasco, M, Carbonell, N, et al Postoperative sotalol versus atenolol for atrial fibrillation after cardiac surgery.Ann Thorac Surg2004;77,838-843. [CrossRef] [PubMed]
 
Adulrahman, O, Dale, HT, Levin, V, et al The comparative of low dose sotalol vs metoprolol in the prevention of post operative supraventricular arrhythmias. Eur Heart J. 1999;;20(suppl) ,.:372
 
Parikka, H, Toivonen, L, Heikkila, L, et al A comparison of sotalol and metoprolol in the prevention of atrial fibrillation after coronary artery bypass surgery.J Cardiovasc Pharmacol1988;31,67-73
 
Nystrom, U, Edvardsson, N, Breggren, H, et al Oral sotalol reduces the incidence of atrial fibrillation after coronary artery bypass surgery.Thorac Cardiovasc Surg1993;41,34-37. [CrossRef] [PubMed]
 
Crystal, E, Connolley, SJ, Sleik, K, et al Interventions on prevention of post operative atrial fibrillation in patients undergoing heart surgery: a meta-analysis.Circulation2002;106,75-80. [CrossRef] [PubMed]
 
Yagdi, T, Nalbantgil, S, Ayik, F, et al Amiodarone reduces the incidence of atrial fibrillation after coronary artery bypass grafting.J Thorac Cardiovasc Surg2003;125,1420-1425. [CrossRef] [PubMed]
 
Tokmakoglu, H, Kandemir, O, Gunaydin, S, et al Amiodarone versus digoxin and metoprolol combination for the prevention of postcoronary bypass atrial fibrillation.Eur J Cardiothorac Surg2002;21,401-405. [CrossRef] [PubMed]
 
White, CM, Giri, S, Tsikouris, JP, et al A comparison of two individual amiodarone regimens to placebo in open heart surgery patients.Ann Thorac Surg2002;74,69-74. [CrossRef] [PubMed]
 
Ronald, A, Dunning, J Bi-atrial pacing significantly reduces the Incidence of atrial fibrillation post cardiac surgery.Interact Cardiovasc Thorac Surg2005;4,33-40. [CrossRef] [PubMed]
 
To the Editor:

I thank Dr. Dunning for his kind and thoughtful comments. He has clearly documented more recent additional studies that are related to the topic of atrial fibrillation after cardiac surgery.

The development of clinical practice guidelines is an evolving process. We have all become aware of the time constraints in developing these guidelines, and have looked to methodologies that will expedite the development and analytical processes. We are already facing the prospect of revising the guidelines to make them more current, and I can assure him that the studies he has cited will be reviewed in the process. Again, I thank Dr. Dunning for his comments and contribution.


Figures

Tables

References

McKeown, PP, Gutterman, D (2005) Executive summary: American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillation after cardiac surgery.Chest128(suppl),1-5
 
Rostron, A, Sanni, A, Dunning, J Does magnesium prophylaxis reduce the incidence of atrial fibrillation following coronary bypass surgery?Interact Cardiovasc Thorac Surg2005;4,52-58. [CrossRef] [PubMed]
 
Miller, S, Crystal, E, Garfinkle, M, et al Effects of magnesium on atrial fibrillation after cardiac surgery: a meta-analysis.Heart2005;91,618-623. [CrossRef] [PubMed]
 
Alghamdi, AA, Al-Radi, OO, Latter, DA Intravenous magnesium for prevention of atrial fibrillation after coronary artery bypass surgery: a systematic review and meta-analysis.J Card Surg2005;20,293-299. [CrossRef] [PubMed]
 
Patel, A, Dunning, J Is sotalol more effective than standard beta-blockers for prophylaxis of atrial fibrillation during cardiac surgery?Interact Cardiovasc Thorac Surg1005;4,147-150
 
Auer, J, Webber, T, Berent, R, et al A comparison between oral antiarrhythmic drugs in the prevention of post operative atrial fibrillation (SPPAF), a randomised placebo controlled trial.Am Heart J2004;147,636-643. [CrossRef] [PubMed]
 
Sanjuan, R, Blasco, M, Carbonell, N, et al Postoperative sotalol versus atenolol for atrial fibrillation after cardiac surgery.Ann Thorac Surg2004;77,838-843. [CrossRef] [PubMed]
 
Adulrahman, O, Dale, HT, Levin, V, et al The comparative of low dose sotalol vs metoprolol in the prevention of post operative supraventricular arrhythmias. Eur Heart J. 1999;;20(suppl) ,.:372
 
Parikka, H, Toivonen, L, Heikkila, L, et al A comparison of sotalol and metoprolol in the prevention of atrial fibrillation after coronary artery bypass surgery.J Cardiovasc Pharmacol1988;31,67-73
 
Nystrom, U, Edvardsson, N, Breggren, H, et al Oral sotalol reduces the incidence of atrial fibrillation after coronary artery bypass surgery.Thorac Cardiovasc Surg1993;41,34-37. [CrossRef] [PubMed]
 
Crystal, E, Connolley, SJ, Sleik, K, et al Interventions on prevention of post operative atrial fibrillation in patients undergoing heart surgery: a meta-analysis.Circulation2002;106,75-80. [CrossRef] [PubMed]
 
Yagdi, T, Nalbantgil, S, Ayik, F, et al Amiodarone reduces the incidence of atrial fibrillation after coronary artery bypass grafting.J Thorac Cardiovasc Surg2003;125,1420-1425. [CrossRef] [PubMed]
 
Tokmakoglu, H, Kandemir, O, Gunaydin, S, et al Amiodarone versus digoxin and metoprolol combination for the prevention of postcoronary bypass atrial fibrillation.Eur J Cardiothorac Surg2002;21,401-405. [CrossRef] [PubMed]
 
White, CM, Giri, S, Tsikouris, JP, et al A comparison of two individual amiodarone regimens to placebo in open heart surgery patients.Ann Thorac Surg2002;74,69-74. [CrossRef] [PubMed]
 
Ronald, A, Dunning, J Bi-atrial pacing significantly reduces the Incidence of atrial fibrillation post cardiac surgery.Interact Cardiovasc Thorac Surg2005;4,33-40. [CrossRef] [PubMed]
 
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    Print ISSN: 0012-3692
    Online ISSN: 1931-3543