Jeffrey L. Anderson, MD, FACC, FAHA, Chair 

Jonathan L. Halperin, MD, FACC, FAHA, Chair-Elect 

Nancy M. Albert, PhD, RN, FAHA

Biykem Bozkurt, MD, PhD, FACC, FAHA

Ralph G. Brindis, MD, MPH, MACC

Mark A. Creager, MD, FACC, FAHA[#][1]

Lesley H. Curtis, PhD, FAHA

David DeMets, PhD[#][1]

Robert A

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2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society

Preamble 2072

1. Introduction 2074

2. Clinical Characteristics and Evaluation of AF 2076

3. Thromboembolic Risk and Treatment 2077

4. Rate Control: Recommendations 2079

5. Rhythm Control: Recommendations 2080

6. Specific Patient Groups and AF: Recommendations 2086

7. Evidence Gaps and Future Research Directions 2089

References 2090

Appendix 1. Author Relationships With Industry and Other Entities (Relevant) 2095

Appendix 2. Reviewer Relationships With Industry and Other Entities (Relevant) 2097

Appendix 3. Initial Clinical Evaluation in Patients With AF 2104

The medical profession should play a central role in evaluating the evidence related to drugs, devices, and procedures for the detection, management, and prevention of disease. When properly applied, expert analysis of available data on the benefits and risks of these therapies and procedures can improve the quality of care, optimize patient outcomes, and favorably affect costs by focusing resources on the most effective strategies. An organized …

/pdf/2014-aha-acc-hrs-guideline-for-the-management-of-patients-4kflhgi5zh.pdf

2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary

https://cdr.lib.unc.edu/downloads/9p290c48k

ACC/AHA Guidelines for Coronary Artery Bypass Graft Surgery A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery)

ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: Summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (committee to update the 1999 guidelines for coronary artery bypass graft surgery)

Background Acute changes in cerebral function after elective coronary bypass surgery are a difficult clinical problem. We carried out a multicenter study to determine the incidence and predictors of — and the use of resources associated with — perioperative adverse neurologic events, including cerebral injury. Methods In a prospective study, we evaluated 2108 patients from 24 U.S. institutions for two general categories of neurologic outcome: type I (focal injury, or stupor or coma at discharge) and type II (deterioration in intellectual function, memory deficit, or seizures). Results Adverse cerebral outcomes occurred in 129 patients (6.1 percent). A total of 3.1 percent had type I neurologic outcomes (8 died of cerebral injury, 55 had nonfatal strokes, 2 had transient ischemic attacks, and 1 had stupor), and 3.0 percent had type II outcomes (55 had deterioration of intellectual function and 8 had seizures). Patients with adverse cerebral outcomes had higher in-hospital mortality (21 percent of patients ...

https://www.nejm.org/doi/pdf/10.1056/NEJM199612193352501

Adverse Cerebral Outcomes after Coronary Bypass Surgery

Objective. —To determine the incidence, predictors, and cost of atrial fibrillation and flutter (AFIB) following coronary artery bypass graft (CABG) surgery. Design. —Prospective observational study (MultiCenter Study of Perioperative Ischemia). Setting. —Twenty-four university-affiliated hospitals in the United States from 1991 to 1993. Subjects. —A total of 2417 patients undergoing CABG with or without concurrent valvular surgery selected using a systematic sampling interval. Measurements. —Detailed preoperative, intraoperative, and postoperative data collected on standardized reporting forms. Results. —The overall incidence of postoperative AFIB was 27%. Independent predictors of postoperative AFIB included advanced age (odds ratio [OR], 1.24 per 5-year increase; 95% confidence interval [CI], 1.18-1.31); male sex (OR, 1.41; 95% CI, 1.09-1.81); a history of AFIB (OR, 2.28; 95% CI, 1.74-3.00); a history of congestive heart failure (OR, 1.31; 95% CI, 1.04-1.64); and a precardiopulmonary bypass heart rate of more than 100 beats per minute (OR, 1.59; 95% CI, 1.00-.00-2.55). Surgical practices such as pulmonary vein venting (OR, 1.44; 95% CI, 1.13-1.83); bicaval venous cannulation (OR, 1.40; 95% CI, 1.04-1.89); postoperative atrial pacing (OR, 1.27; 95% CI, 1.00-1.62); and longer cross-clamp times (OR, 1.06 per 15 minutes; 95% CI, 1.00-1.11) also were identified as independent predictors of postoperative AFIB. Patients with postoperative AFIB remained an average of 13 hours longer in the intensive care unit and 2.0 days longer in the ward when compared with patients without AFIB. Conclusion. —Postoperative AFIB is common after CABG surgery and has a significant effect on both intensive care unit and overall hospital length of stay. In addition to expected demographic factors, certain surgical practices increase the risk of postoperative AFIB. Randomized controlled trials are necessary to determine if modification of these surgical practices, especially in patients at high risk, would decrease the incidence of postoperative AFIB.

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=jama&articleId=405813&pdfFileName=jama_276_4_031.pdf

Atrial fibrillation following coronary artery bypass graft surgery: Predictors, outcomes, and resource utilization

Background An estimated 20% of allogeneic blood transfusions in the United States are associated with cardiac surgery. National consensus guidelines for allogeneic transfusion associated with coronary artery bypass graft (CABG) surgery have existed since the mid- to late 1980s. The appropriateness and uniformity of institutional transfusion practice was questioned in 1991. An assessment of current transfusion practice patterns was warranted. Methods The Multicenter Study of Perioperative Ischemia database consists of comprehensive information on the course of surgery in 2,417 randomly selected patients undergoing CABG surgery at 24 institutions. A subset of 713 patients expected to be at low risk for transfusion was examined. Allogeneic transfusion was evaluated across institutions. Institution as an independent risk factor for allogeneic transfusion was determined in a multivariable model. Results Significant variability in institutional transfusion practice was observed for allogeneic packed red blood cells (PRBCs) (27-92% of patients transfused) and hemostatic blood components (platelets, 0-36%; fresh frozen plasma, 0-36%; cryoprecipitate, 0-17% of patients transfused). For patients at institutions with liberal rather than conservative transfusion practice, the odds ratio for transfusion of PRBCs was 6.5 (95% confidence interval [CI], 3.8-10.8) and for hemostatic blood components it was 2 (95% CI, 1.2-3.4). Institution was an independent determinant of transfusion risk associated with CABG surgery. Conclusions Institutions continue to vary significantly in their transfusion practices for CABG surgery. A more rational and conservative approach to transfusion practice at the institutional level is warranted.

Variability in Transfusion Practice for Coronary Artery Bypass Surgery Persists Despite National Consensus Guidelines A 24-Institution Study

In Reply. —In our study of 2417 patients undergoing coronary artery bypass graft surgery at 24 McSPI sites, there was no association (relative risk [RR], 0.95; 95% confidence interval [CI], 0.72-1.27) between the intraoperative use of an IABP and the occurrence of postoperative AF. In the study by Aranki et al, 1 only 25 patients were treated with an IABP, whereas in our larger study, 142 patients required an intraoperative IABP.

R. Parks

Papers

Atrial fibrillation following coronary artery bypass graft surgery: Predictors, outcomes, and resource utilization

Variability in Transfusion Practice for Coronary Artery Bypass Surgery Persists Despite National Consensus Guidelines A 24-Institution Study

Atrial Fibrillation Following Coronary Artery Bypass Graft Surgery-Reply

Institutional variability in red blood cell conservation practices for coronary artery bypass graft surgery

Safety and efficacy of shed mediastinal blood transfusion after cardiac surgery: A multicenter observational study