CHADS₂ Flags Atrial Fibrillation in Noncardiac Patients

Another Medscape article.

Some people could be interested because of the following statements:

There was an association between the preoperative use of beta blockers and postop atrial fibrillation, which was a surprise, Dr Kooda pointed out. "This is counterintuitive, especially considering that the bulk of the literature reports a decreased risk of atrial fibrillation with beta blockers at baseline," she explained. "Our current hypothesis is that these are perhaps the patients with the highest percentage of risk factors at baseline."

This finding could also be related to a withdrawal effect from the drugs, said study investigator Arun Subramanian, MBBS, also from the Mayo Clinic in Rochester.

"It is well known that if patients suddenly stop beta blockers, they develop withdrawal, including an increase in heart rate and the development of chest pain," he told Medscape Medical News.

"Surgical patients, many times, do not take their medications while fasting for surgery. Also, postoperatively, bowel function slows down and beta blocker pills may not be well absorbed," he explained.

"I favor this explanation — that beta blocker withdrawal increases the risk of atrial fibrillation," Dr Subramanian said. "We are investigating this further."

2 Replies

  • Thank you for the article posting : )

  • Many thanks, EngMac - I have wondered since 2012 if that's what triggered AF in me after an abdominal op before which I was taken off atenolol. Two days later it was severe chest pain and frightening breathlessness in the middle of the night.

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