POST-CARDIAC SURGERY ATRIAL FIBRILLATION UK PRACTICE SURVEY

Introduction:Recommendations for the prevention of postoperative atrial fibrillation (POAF) after cardiac surgery vary among international organizations. To establish “usual care” for a future platform trial aimed at preventing and managing POAF, a national survey of UK practice was conducted. In parallel, current international guidelines addressing the prevention and management of atrial fibrillation following cardiac surgery were reviewed to contextualize the survey findings. Objectives: Postoperative atrial fibrillation affects approximately 30% of patients undergoing cardiac surgery and represents the most common postoperative complication. This study aimed to evaluate current UK practice in the prevention and management of POAF and to compare it with existing guideline recommendations. Design: A mixed-methods study comprising a structured literature review and a national online survey. Participants All 35 National Health Service (NHS) cardiac surgery centers in the United Kingdom were invited to participate through a national research network. Measurements and Key Findings Five major international guidelines were identified. All recommended β-blockade for the prevention of POAF. Both rate and rhythm control strategies were advised for treatment, with cardioversion reserved for hemodynamically unstable patients. Anticoagulation was recommended for patients remaining in atrial fibrillation beyond 48 hours, with continued rhythm and anticoagulation therapy guided by extended monitoring. Responses were received from 31 of 35 centers (89%). Eleven centers (35.5%) followed local POAF prevention guidelines, four (13%) followed Society of Cardiovascular Anesthesiologists/European Association of Cardiothoracic Anaesthesiology guidelines, four followed National Institute for Health and Care Excellence (NICE) guidance, and four adhered to other protocols. Eight centers (26%) reported having no formal POAF prevention protocol, and 28 centers (90%) did not perform routine POAF risk stratification. Most centers (23/31, 74%) lacked a structured POAF care bundle, although 14 centers (45%) actively attempted prophylaxis in patients presenting in sinus rhythm. The most commonly used preventive strategies were postoperative β-blockers (23/31, 74%), magnesium supplementation (20/31, 64.5%), and maintenance of serum potassium around 4.5 mmol/L (26/31, 84%). Conclusions:β-blockade remains the cornerstone of POAF prevention following cardiac surgery. In UK practice, β-blockers alongside optimization of serum potassium and magnesium levels constitute the principal preventive measures. Despite the high incidence of POAF, formal risk stratification and standardized prevention pathways are not widely implemented, highlighting a significant opportunity for systematized intervention and future clinical trials.