[2014] 1.10 Preventing and managing postoperative atrial fibrillation Preventing postoperative atrial fibrillation 1.10.1 In people having cardiothoracic surgery: reduce the risk of postoperative atrial fibrillation by offering 1 of the following: amiodarone a standard beta-blocker (that is, a beta-blocker other than sotalol) a rate-limiting calcium-channel blocker (diltiazem or verapamil) do not offer digoxin. [2006, amended 2014] In April 2021, this was an off-label use of diltiazem. See NICE's information on prescribing medicines. 1.10.2 In people having cardiothoracic surgery who are already on beta-blocker therapy, continue this treatment unless contraindications develop (such as postoperative bradycardia or hypotension). [2006, amended 2014] 1.10.3 Do not start statins in people having cardiothoracic surgery solely to prevent postoperative atrial fibrillation. [2021] 1.10.4 In people having cardiothoracic surgery who are already on statins, continue this treatment. For further advice on statins for the prevention of cardiovascular disease, see NICE's guideline on cardiovascular disease: risk assessment and reduction. [2021] For a short explanation of why the committee made the 2021 recommendations and how they might affect practice, see the rationale and impact section on preventing postoperative atrial fibrillation. Full details of the evidence and the committee's discussion are in evidence review M: statins for preventing atrial fibrillation after cardiothoracic surgery. Managing postoperative atrial fibrillation Atrial fibrillation after cardiothoracic surgery 1.10.5 Consider either a rhythm-control or rate-control strategy for the initial treatment of new-onset postoperative atrial fibrillation after cardiothoracic surgery. [2021] 1.10.6 If a rhythm-control strategy is chosen, reassess the need for antiarrhythmic drug treatment at a suitable time point (usually at around Atrial fibrillation after non-cardiothoracic surgery 1.10.7 Manage postoperative atrial fibrillation after non-cardiothoracic surgery in the same way as for new-onset atrial fibrillation with any other cause. 