Beta blockers should be reinstituted as soon as possible after CABG in all patients without contra- indications to reduce the incidence or clinical se- quelae of AF.604 608,608a 608c (Level of Evidence: B) Class IIa 1. Preoperative administration of amiodarone to re- duce the incidence of postoperative AF is reasonable for patients at high risk for postoperative AF who have contraindications to beta blockers.1036 (Level of Evidence: B) 2. Digoxin and nondihydropyridine calcium channel blockers can be useful to control the ventricular rate in the setting of AF but are not indicated for prophylaxis.606,1037 1041 (Level of Evidence: B) AF immediately after CABG, occurring in 20% to 50% of patients, is often difficult to manage and is associated with a substantially increased risk of morbidity (particularly dis- abling embolic events) and mortality. A prospective observa- tional study of 1878 consecutive subjects undergoing CABG noted that post-CABG AF was associated with a 4-fold increased risk of disabling embolic stroke and a 3-fold increased risk of cardiac-related death.607 The incidence of postoperative AF is increased in the presence of advanced patient age, male sex, PAD, chronic lung disease, concomitant valvular heart disease, left atrial enlargement, previous cardiac surgery, preoperative atrial tachyarrhythmias, pericarditis, and elevated postoperative adrenergic tone. However, many subjects have none of these factors, yet they develop AF in the immediate postoperative period. Postoperative AF almost always occurs within 5 days postoperatively, with a peak incidence on the second postop- erative day.608 Numerous trials have assessed the efficacy of various pharmacologic agents in preventing post-CABG AF, including beta-adrenergic-blockers, various antiarrhythmic agents, glucocorticosteroids, hormonal agents (eg, triiodothy- ronine), and even statins. Preoperative and postoperative beta blockers (or possibly amiodarone) are most effective at reducing its incidence, with several RCTs showing that they effectively accomplish this goal. 