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Mon, 11/15/2021 - 23:28

Hi Kyla! Great work on the summary of the presentation, and I think you did an excellent job handling the virtual question period.

I found the discussion between physicians at these Rounds particularly interesting. In addition to Dr. Conen discussing the use of biomarkers for predicting perioperative AF, Dr. Johri was also bringing up the use of non-invasive imaging as a predictive tool. Perioperative AF is associated with adverse cardiovascular outcomes, including stroke and myocardial infarction (MI) (1). Since perioperative AF is thought to be self-correcting and usually benign, it made me wonder what the follow-up of these patients is like (2). For some, this may be the first cardiac symptom they notice, and they may benefit from a more in-depth cardiovascular assessment after their surgical recovery. It seems that post-operative cardiac care for these patients involves regaining hemodynamic stabilization and organ perfusion, Beta-blockers, digoxin, or antithrombotic therapy (3). So far, I have found limited information on these patients' subsequent referrals to cardiology. Given perioperative AF's association with events, it seems reasonable for these patients to undergo outpatient monitoring through echocardiography to assess for arrhythmias, valvular issues, or coronary artery disease. This may detect risk features of stroke and MI so that more invasive interventions could then prevent the occurrence of these events. Do you think that AF patients should receive long-term cardiac follow-up, or do you see that causing undue stress on the patients and unnecessary strain on the healthcare system?

1. Conen, D., Alonso-Coello, P., Douketis, J., Chan, M., Kurz, A., & Sigamani, A. et al. (2019). Risk of stroke and other adverse outcomes in patients with perioperative atrial fibrillation 1 year after non-cardiac surgery. European Heart Journal. doi: 10.1093/eurheartj/ehz431

2. Karamchandani, Kunal MD, FCCP*; Khanna, Ashish K. MD, FCCP, FCCM†,‡; Bose, Somnath MD§; Fernando, Rohesh J. MD, FASE‖; Walkey, Allan J. MD, MSc¶,# Atrial Fibrillation: Current Evidence and Management Strategies During the Perioperative Period, Anesthesia & Analgesia: January 2020 - Volume 130 - Issue 1 - p 2-13 doi: 10.1213/ANE.0000000000004474

3. Frendl, G., Sodickson, A., Chung, M., Waldo, A., Gersh, B., & Tisdale, J. et al. (2014). 2014 AATS guidelines for the prevention and management of perioperative atrial fibrillation and flutter for thoracic surgical procedures. The Journal Of Thoracic And Cardiovascular Surgery, 148(3), e153-e193. doi: 10.1016/j.jtcvs.2014.06.036


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