ECG monitoring after cardiac surgery: postoperative atrial fibrillation and the atrial electrogram.

Atrial fibrillation is one of the most common complications after cardiac surgery and is associated with adverse outcomes such as increased mortality, neurological problems, longer hospitalizations, and increased cost of care. Major risk factors for the development of postoperative atrial fibrillation include older age and a history of atrial fibrillation. beta-Blockers are the most effective preventive therapy, although sotalol and amiodarone can also be used for prophylaxis. In the postoperative period, the nurse plays an important role in the early detection of atrial fibrillation by the recording of an atrial electrogram, which is easily obtained from the bedside monitor. Because an atrial electrogram records larger atrial activity than ventricular activity, it can be invaluable in establishing the diagnosis of postoperative atrial fibrillation. Once atrial fibrillation begins, treatment can be started with either rhythm conversion or rate-controlling medications.