When should we discontinue antiarrhythmic therapy for atrial fibrillation after abdominal surgery?

Background The occurrence of peri-operative AF after abdominal surgery is a clinical condition burdened by several complications, especially in the elderly [1-3]. When AF is successfully converted to sinus rhythm, it is unlikely to recur, and nearly all of these patients are discharged from the hospital in sinus rhythm. It is not clear how soon these patients may discontinue antiarrhythmic therapy to avoid drugs side effects without risking recurrence of AF. The recurrence of AF needs different kind of treatment. Medical therapy includes various antiarrhythmic drugs to control heart rate and restore sinus rhythm and anticoagulation to reduce the tromboembolic risk [4]. Overactivation of sympathetic nervous system, related to surgery stress [5], could be reduced by the treatment with antiarrhythmic drugs, such as Beta Blockers, and may reduce the incidence of AF recurrence [6-10].