Prophylaxis and management of atrial fibrillation after general thoracic surgery.

Atrial fibrillation (AF) commonly affects patients after general thoracic surgery. Postoperative AF increases hospital stay and charges. Effective prophylaxis and treatment is the goal. Calcium channel blockers prevent postoperative AF. Beta blockers are a less viable choice. Amiodarone prophylaxis should be avoided in patients with pulmonary dysfunction or who require pneumonectomy. In management of AF, a brief trial of rate-control agents is appropriate; however, chemical cardioversion with rhythm-control agents should be instituted after 24 hours. High-risk patients with history of stroke or transient ischemic attack, or with two or more risk factors for thromboembolism should receive anticoagulation therapy.