Post-operative Atrial Fibrillation — EECC MCQ

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ModerateArrhythmia & ElectrophysiologyPost-operative Atrial FibrillationEECC

A 65-year-old man develops atrial fibrillation on the second day after coronary artery bypass grafting. His heart rate is 130 bpm, BP 115/75 mmHg, and he has no heart failure. He was in sinus rhythm preoperatively. What is the most appropriate initial management?

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Correct answer: C — Rate control with intravenous metoprolol

Post-operative AF occurs in 20-40% of patients after cardiac surgery and is usually self-limiting. Initial management is rate control, with intravenous beta-blocker (metoprolol or esmolol) as first-line in haemodynamically stable patients without contraindications (Class I). Amiodarone is an alternative if beta-blockers are contraindicated or ineffective but carries more side effects. Flecainide is not recommended in post-cardiac surgery patients due to the risk of pro-arrhythmia in the context of recent ischaemia/surgery. Post-operative AF typically resolves within 6-8 weeks, and long-term anticoagulation is generally not needed if sinus rhythm is restored, though anticoagulation should be considered if AF persists >48 hours based on CHA₂DS₂-VA score.

Reference: ESC (2024): Guidelines for the Management of Atrial Fibrillation