9th March 2018, Volume 131 Number 1471

Alyssa Kirby, Sisira Jayathissa

Atrial fibrillation (AF) is a common arrhythmia affecting hospitalised patients, and associated with increased mortality and morbidity.1 It is the most common sustained tachyarrhythmia post-operatively.2 The global incidence of AF…

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Atrial fibrillation is an abnormal heart rhythm which can occur around the time of surgery. Atrial fibrillation can lead to serious complications, which include an increased risk of having a stroke in the future. It is not clear whether or not atrial fibrillation before or after surgery should be managed in the same way that patients without surgery are treated. This paper shows current practice at this hospital varies from patient to patient, due to a lack of strong evidence to guide treatment.



Atrial fibrillation (AF) is a common arrhythmia encountered perioperatively in patients undergoing non-cardiac surgery. There is emerging evidence suggesting high risk of ischaemic stroke. There are no clear guidelines surrounding initiation of anticoagulation in this setting. This study evaluates current practice in anticoagulant management of new perioperative AF at Hutt Hospital.


We have undertaken a retrospective study of 3,558 patients aged 60 years and over admitted for non-cardiac surgery at Hutt Hospital in 2014, to assess incidence of new AF/flutter and review how they were managed in regards to anticoagulation.


We identified 28 patients as having “new AF/flutter” with CHA2DS2-VASc scores between 1 and 8. Anticoagulation management was inconsistent, with only some patients receiving anticoagulation if using CHA2DS2-VASc score as a marker of indication for treatment.


There is insufficient evidence and lack of clear guidelines in this area to enable consistent and evidence-based management of patients with new AF identified perioperatively. Until such guidelines are available we suggest all such patients are individually assessed and treated depending on their individual risk/benefit analysis. Multiple factors such as bleeding risk, CHA2DS2-VASc score and perhaps duration of AF need to be considered.

Author Information

Alyssa Kirby, Advanced Trainee in Cardiology and General and Acute Care Medicine, Department of General Medicine, Hutt Hospital, Lower Hutt; Sisira Jayathissa, Consultant Physician, Department of General Medicine, Hutt Hospital, Lower Hutt.


Sharon Morse, Data Analyst, Business Information, Hutt Valley District Health Board; 
Michele Paku, Manager Clinical Records, Clinical Coding, Admin Relief Clerks, Central Typing Services, Hutt Valley District Health Board; Consultant Cardiologists and Electrophysiologists, Hutt and Wellington Regional Hospitals.


Dr Alyssa Kirby, Department of Cardiology, Wellington Regional Hospital, Private Bag 7902, Wellington South.

Correspondence Email


Competing Interests



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