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Optimal practice review: recommendation reminders detail

Recommendation reminder 4: In patients undergoing cardiothoracic surgery:

Guidance:Atrial fibrillation
Date issued:June 2006

Atrial fibrillation (AF) is a condition that affects the heart. It occurs when the electrical impulses controlling the heartbeat become disorganised, so that the heart beats irregularly and too fast. As a result, the heart is not able to efficiently pump blood around the body and the pulse is irregular. This may cause symptoms such as palpitations, chest pain or discomfort, shortness of breath, dizziness and fainting. If severe, these can be life threatening and require immediate treatment. However, many people with AF have no or only mild symptoms.

AF may increase the risk of blood clots because when the heart beats irregularly, the blood does not flow properly through the heart and the rest of the body. People with AF may need medication to reduce or prevent this risk.

Cardiothoracic surgery is surgery on the heart or chest area. Medications (such as amiodarone, beta-blockers, sotalol and calcium antagonists) can be administered to reduce the risk of AF following this type of surgery. This type of AF is known as ‘postoperative AF’.

Digoxin is a drug that is widely used in the treatment of various heart conditions, such as AF and heart failure that cannot be controlled by other medication.

However, the evidence reviewed by the NICE Guideline Development Group indicated that digoxin did not reduce postoperative AF when compared with no treatment. It was agreed that digoxin is not effective in preventing postoperative AF in patients undergoing cardiothoracic surgery and is therefore not recommended for this use.

 

This page was last updated: 09 September 2009

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.