When should we discontinue antiarrhythmic therapy for atrial fibrillation after abdominal surgery?

Gennaro Pagano,Loredana Iannone,Rita Compagna,Dario Leosco,Corrado Rispoli,Nicola Rocco,Serena Testa,Nicola Ferrara,Antonello Accurso,Bruno Amato

doi:10.1186/1471-2482-13-s1-a35

Abstract

Aim of the studyThe purpose of this study was to determine whether theduration of antiarrhythmic therapy after discharge fromthe hospital following abdominal surgery is related to theincidence of atrial fibrillation (AF) recurrence in elderlypatients with the occurrence of peri-operative AF.BackgroundThe occurrence of peri-operative AF after abdominal sur-gery is a clinical condition burdened by several complica-tions, especially in the elderly [1-3]. When AF issuccessfully converted to sinus rhythm, it is unlikely torecur, and nearly all of these patients are discharged fromthe hospital in sinus rhythm. It is not clear how soonthese patients may discontinue antiarrhythmic therapy toavoid drugs side effects without risking recurrence of AF.The recurrence of AF needs different kind of treat-ment. Medical therapy includes various antiarrhythmicdrugs to control heart rate and restore sinus rhythm andanticoagulation to reduce the tromboembolic risk [4].Overactivation of sympathetic nervous system, related tosurgery stress [5], could be reduced by the treatmentwith antiarrhythmic drugs, such as Beta Blockers, andmay reduce the incidence of AF recurrence [6-10].MethodsA pilot study was conducted in 19 elderly patients (age> 65 years) who underwent abdominal surgery (rightemicolectomy, sigmoidectomy and anterior rectal resec-tion) and with occurrence of peri-operative AF thatsuccessfully reverted to sinus rhythm. They were pro-spectively randomized at dismissal to receive antiar-rhythmic therapy for 1 week (six patients in group A), 3weeks (seven patients in group B), or 6 weeks (sixpatients in group C). Patients were followed up for anadditional 4 weeks after discontinuation of antiarrhyth-mic therapy for detection of recurrence of AF.ResultsThere was no significant difference in the recurrenceof AF among groups (0%, 2%, and 0% for groups A, B,and C, respectively).ConclusionsIn elderly patients with peri-operative AF after abdominalsurgery, converted to normal sinus rhythm before hospitaldischarge, have a benign course and the duration of antiar-rhythmic therapy shorter than one week is appropriate.

Highlights

The occurrence of peri-operative atrial fibrillation (AF) after abdominal surgery is a clinical condition burdened by several complications, especially in the elderly [1,2,3]
When AF is successfully converted to sinus rhythm, it is unlikely to recur, and most of these patients are discharged from the hospital in sinus rhythm
A pilot study was conducted in 19 elderly patients who underwent abdominal surgery and with occurrence of peri-operative AF that

Summary

Introduction

The occurrence of peri-operative AF after abdominal surgery is a clinical condition burdened by several complications, especially in the elderly [1,2,3]. Background The occurrence of peri-operative AF after abdominal surgery is a clinical condition burdened by several complications, especially in the elderly [1,2,3]. When AF is successfully converted to sinus rhythm, it is unlikely to recur, and most of these patients are discharged from the hospital in sinus rhythm.

Objectives

Results

Conclusion