Rate vs rhythm: beta blockers and antiarrhythmics as pharmacological options for the treatment of postoperative atrial fibrillation

Postoperative atrial fibrillation is one of the most recognised complications of cardiac surgery. Although its exact pathophysiology remains unknown, evidence suggests that it is multifactorial and that it directly affects patient outcomes post cardiac surgery. It is associated with an increased risk of heart failure, renal failure, stroke and mortality. Pharmacological agents such as beta blockers and antiarrhythmic drugs are well established and extensively used for both the prevention and treatment of postoperative atrial fibrillation. This article will explore the pharmacological treatment of postoperative atrial fibrillation with specific reference to metoprolol and amiodarone, along with the pharmacokinetic and pharmacodynamic effects of both drugs. It will briefly discuss the evidence reviewed regarding the effectiveness of these drugs for postoperative atrial fibrillation and the recommendations from the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery on how postoperative atrial fibrillation should be treated.