Priority 9 from the Heart Surgery PSP

UNCERTAINTY: What are the most effective ways of preventing and treating post-operative atrial fibrillation? (JLA PSP Priority 9)
Overall ranking 9
JLA question ID 0088/9
Explanatory note New onset atrial fibrillation can occur in about 30% of people undergoing heart surgery where it is associated with morbidity including stroke, prolonged hospitalisation, and increased healthcare costs. There are no effective interventions that prevent or reduce the frequency of postoperative atrial fibrillation (AF). The evidence in favour of both pharmacological and non-pharmacological prophylaxis is low because of the quality and the heterogeneity of the data, and choice of the best individualized intervention for patients is still problematic. Moreover, recommendations for management of anticoagulation in postoperative atrial fibrillation in the EACTS guidelines remain class IIa level C.
~ What is the best option for management of postoperative AF? are there patient sub groups according to pathology/ co-morbidities that affect the management strategies? 
Evidence

Sousa-Uva M, Head SJ, Milojevic M, Collet JP, Landoni G, Castella M, et al. 2017 EACTS Guidelines on perioperative medication in adult cardiac surgery. Eur J Cardiothorac Surg. 2018;53(1):5-33; Huffman MD, Karmali KN, Berendsen MA, Andrei AC, Kruse J, McCarthy PM, et al. Concomitant atrial fibrillation surgery for people undergoing cardiac surgery. Cochrane Database of Systematic Reviews. 2016(8);  
Health Research Classification System category Cardiovascular
Extra information provided by this PSP
Original uncertainty examples What is the best option for management of postoperative AF? ~ Use of NOACs for post op AF rather than warfarin? ~ How can atrial fibrillation occurence be minimised/prevented post operatively? 
Submitted by 1 x patient, 1 x carer, 13 x healthcare professional 
PSP information
PSP unique ID 0088
PSP name Heart Surgery
Total number of uncertainties identified by this PSP. 45  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 11 July 2019