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Name
Cassie Brand

Tue, 11/16/2021 - 21:54

Kyla,

Excellent job leading this weeks discussion and preparing this very well thought out summary our time with Dr. Conen. As alluded to by the current perioperative AF clinical trials, effective preventative and management strategies are still being investigated. It has been suggested that classification of AF as paroxysmal (>48 h), persistent (>7 days), or permanent could help guide perioperative management (1). Perhaps this could (if not already) help guide postoperative management in preventing further cardiovascular events such as the first clinical trial you mentioned.

While management can be challenging and predictable, a focus has been placed on prevention (2). We spent most of our time learning about clinical trials pertaining to anticoagulants and anti-inflammatory agents. Dr. Conen briefly mentioned antiarrhythmic medications, which made me wonder if this is currently being investigated for prevention of perioperative AF? It was found that beta blockers administered prior to non-cardiac surgery reduced the risk of myocardial infarctions, but increased the risk of other complications (3). I would be curious to see a study on the effects of beta blockers in preventing perioperative AF, or wonder if there is a reason that beta blockers are not an area of focus for AF prevention.

Great job once again!

Best,
Cassie

(1) Liao, H. R., Poon, K. S., & Chen, K. B. (2013). Atrial fibrillation: An anesthesiologist's perspective. Acta Anaesthesiologica Taiwanica, 51(1), 34-36.
(2) Karamchandani, K., Khanna, A. K., Bose, S., Fernando, R. J., & Walkey, A. J. (2020). Atrial fibrillation: current evidence and management strategies during the perioperative period. Anesthesia & Analgesia, 130(1), 2-13.
(3) Wijeysundera, D. N., Duncan, D., Nkonde-Price, C., Virani, S. S., Washam, J. B., Fleischmann, K. E., & Fleisher, L. A. (2014). Perioperative beta blockade in noncardiac surgery: a systematic review for the 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. Circulation, 130(24), 2246-2264.

Name
Cassie Brand

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