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CLINICAL STATEMENTS AND GUIDELINES Circulation. 2024;149:e1–e156. DOI: 10.1161/CIR.0000000000001193 January 2, 2024 e103 Joglar et al 2023 Guideline for the Diagnosis and Management of Atrial Fibrillation blockers.1–4 A randomized trial showed no significant clinical differences comparing a strategy of rate-control versus rhythm-control medications for patients who are hemodynamically stable.5 For those with poorly controlled AF, cardioversion is reasonable, but for those with >48 hours of AF, imaging of the LAA (even if surgically closed) should be considered.5,6 The use of cardioversion and imaging in postoperative patients is a judgment call considering the patient’s clinical condition. For patients who develop postoperative AF, including during follow-up postdischarge, rhythm assessment, and possible cardioversion for the small number who are still in AF, should be considered.5,6 Colchicine had been shown to be effective, but more recent studies did not confirm this, and gastrointestinal adverse effects may be significant.8–10 Recommendation-Specific Supportive Text 1. The use of beta blockers to control heart rate is well documented.1–4 Calcium channel blockers are an option for rate control when beta blockers are ineffective.5 2 The use of rate control or rhythm control are both acceptable options in hemodynamically stable patients because neither has a distinct clinical advantage over the other based on a randomized study that included 529 patients. In this study, patients in the rhythm-control group received amiodarone.5,6 3 Cardioversion of patients with sustained post- operative AF is regularly performed, especially for those patients with hemodynamically poorly tolerated AF. Cardioversion is routinely combined with pharmacological therapy, especially amiodarone.5,6 4 A review of 8 observational studies that included 15 335 patients found a protective impact on the mortality rate at 5 years but no differences in thromboembolic events in patients with postoperative AF treated with anticoagulants.7 In general, the duration of anticoagulation is a minimum of 60 days; in the randomized trial of rate control versus rhythm control, if patients remained in AF or had recurrent AF 48 hours after randomization, anticoagulation was recommended to be continued for 60 days, unless complications occurred. Patients should be evaluated before discontinuation to determine underlying rhythm, especially those at high risk for stroke. 5. The need for a rhythm-control strategy should be evaluated postdischarge. Patients who tolerate rate control can be followed and often convert spontaneously after 6 to 8 weeks. A net advantage of rate control is earlier discharge in hemodynamically stable patients. Those who do not convert can be managed accordingly with rhythmcontrol strategy.5,6 Figure 26. Treatment of AF After Cardiac Surgery. Colors correspond to Table 2. AF indicates atrial fibrillation; and HR, heart rate. Downloaded from http://ahajournals.org by on October 7, 2026