Postoperative atrial fibrillation prophylaxis using a novel amiodarone order set

Postoperative atrial fibrillation (POAF) is a well-known complication following anatomic lung resection that occurs in up to 40% of patients without prophylaxis (1-3). In 2011 and 2014 respectively, the Society of Thoracic Surgeons (STS) and the American Association for Thoracic Surgery (AATS) published practice guidelines for the prevention of POAF following lung resection that recommend chemoprophylaxis such as beta blockers (BB), antiarrhythmics and calcium-channel blockers (CCB) (4,5). However, it is unclear if these recommendations are warranted after all types of lung resection. The STS provides an amiodarone dosing recommendation for lobectomy, but not sublobar resection. The AATS estimates the rate of POAF after wedge resection to be <5% and therefore only recommends prophylaxis for anatomic resection. Interestingly, they do not include reference to earlier studies that showed post-wedge resection rates of POAF to be over 20% (6,7). Contemporary data on the rate of POAF following wedge resection is lacking and the literature does not elucidate the need for prophylaxis