Does prophylaxis against atrial fibrillation after cardiac surgery reduce length of stay or hospital costs?

Atrial fibrillation (AF) is common after cardiac surgery and may result in stroke, need for permanent pacemaker, hemodynamic instability, and sustaine d AE Studies determining the effect of prophylaxis against AF in cardiac su rgery on length of stay (LOS) and hospital cost were reviewed. a MEDLINE se arch from January 1966-November 2000 was conducted using the medical subjec t heading (MeSH) "atrial fibrillation." The search was limited to clinical trials in the English language. In five of the seven studies reviewed, the frequency of postoperative AF was significantly reduced with prophylactic a miodarone or sotalol. In only one study were LOS and costs significantly re duced. Whereas there is strong evidence that prophylactic drug therapy redu ces the frequency of postoperative AF, there is little evidence of an econo mic advantage. Future studies are warranted that examine costs beyond initi al hospitalization; compare prophylaxis administered selectively to high-ri sk patients with prophylaxis administered universally; and compare prophyla xis with the combination of rate control and anticoagulation with cardiover sion if AF persists.