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Correspondence  |   September 2003
Disagreement with Conclusions
Author Notes
  • Mt. Sinai Hospital, New York, New York.
Article Information
Correspondence
Correspondence   |   September 2003
Disagreement with Conclusions
Anesthesiology 9 2003, Vol.99, 756. doi:
Anesthesiology 9 2003, Vol.99, 756. doi:
To the Editor:—
I read with interest the review by Dr. Amar 1 on perioperative atrial tachyarrhythmias. I disagree with his conclusion that an initial “rate control strategy” in the management of postoperative atrial fibrillation is reasonable. If 50% of patients managed in this fashion will convert within 24 h, it goes without saying that 50% will not convert within this period of time. According to Amar, after this point in time, the patient runs a 1.7% risk of stroke. Further, anticoagulation will be contraindicated for a period of time in postoperative patients. Therefore, it is my practice and recommendation to try to convert all new onset postoperative atrial fibrillation as early as possible using intravenous amiodarone, or, if possible, oral propafenone or flecainide. My personal experience with amiodarone has been excellent, with a high conversion rate (usually within 6 h using a regimen of a 150-mg bolus followed by a 1-mg/min infusion for 6 h, then 0.5 mg per minute) and virtually no adverse effects.
Reference
Reference
Amar D: Perioperative atrial tachyarrhythmias. A nesthesiology 2002; 97: 1618–23Amar, D