Interventions to prevent postoperative atrial fibrillation in Dutch cardiothoracic centres: a survey study

INTRODUCTION

Postoperative atrial fibrillation (POAF) is a common phenomenon following cardiac surgery. In this study, we assessed current preventive strategies used by Dutch cardiothoracic centres, identified common views on this matter and related these to international guidelines.

METHODS

We developed an online questionnaire and sent it to all cardiothoracic surgery centres in the Netherlands. The questionnaire concerned the management of POAF and the use of pharmaceutical therapies (beta-blockers and calcium antagonists) and non-pharmaceutical methods (posterior left pericardiotomy, pericardial flushing and epicardial botulinum toxin type A injections). Usage of electrical cardioversions, anticoagulants and left atrial appendage closure were also enquired.

RESULTS

Of the 15 centres, 14 (93%) responded to the survey and 13 reported a POAF incidence, ranging from 20 to 30%. Of these 14 centres, 6 prescribed preoperative AF prophylaxis to their patients, of which non-sotalol beta-blockers were prescribed most commonly (57%). Postoperative medication was administered by all centres and included non-sotalol beta-blockers (38%), sotalol (24%), digoxin (14%), calcium antagonists (13%) and amiodarone (10%). Only 2 centres used posterior left pericardiotomy or pericardial flushing as surgical manoeuvres to prevent POAF. Moreover, respondents expressed the need for guidance on anticoagulant use.

CONCLUSION

Despite the use of various preventive strategies, the reported incidence of POAF was similar in Dutch cardiothoracic centres. This study highlights limited use of prophylactic amiodarone and colchicine, despite recommendations by numerous guidelines, and restricted implementation of surgical strategies to prevent POAF.

Thermo-stable Escherichia coli phytase improves growth performance and nutrient utilization in broilers fed mash and pelleted corn-soybean-meal-based diets

The bio-efficacy of Escherichia coli-derived phytase produced by thermo-protective coating technology (coated phytase) was evaluated in mash or pelleted broiler diets. Three hundred and twenty-four broilers were divided into 54 groups of six birds and fed nine corn-based diets (six replicates per diet) from 1 to 22 d of age. The nine diets were a positive control (PC) (calcium, 0.9% and non-phytate phosphorus, 0.45%) fed as mash plus 2 × 4 factorial of a negative control (calcium, 0.78% and non-phytate phosphorus, 0.26%) fed as mash (NC-M) or pellet (NC-P) and with coated phytase at 0, 500, 600 or 700 FTU kg-1. The diets were pelleted at 80°C, and pressure load of 40 psi. Body weight gain (BWG) for the PC diet was higher (P < 0.001) than that for the NC-M or NC-P diet. The BWG and tibia ash were linearly increased (P < 0.001) by increased level of the phytase in NC-M or NC-P diet. The BWG for NC-M or NC-P diet reached that of the PC diet when phytase was supplemented at 600 or 700 FTU kg-1. In conclusion, the coated phytase improved nutrient utilization in broilers, and its bio-efficacy was unaffected by the pelleting process.