University Nursing Assignment: Evidence Based Treatment of AF

This nursing assignment focuses on the evidence-based treatment of arterial fibrillation (AF), a common postoperative complication following cardiac surgeries, particularly coronary artery bypass graft (CABG). The assignment explores the use of amiodarone and beta-blockers as prophylactic treatments. It highlights that amiodarone is often preferred over beta-blockers due to factors like drug receptiveness, long-term safety, pharmacokinetic differences, and the potential for beta-blocker withdrawal complications. The report references several studies supporting amiodarone's efficacy and emphasizes its role as a reliable prophylactic treatment for AF in cardiac surgery patients, especially those who haven't previously used beta-blockers. The assignment also considers the American Heart Association's guidelines and the clinical reasons that support amiodarone over beta blockers in managing and preventing AF. The report concludes that amiodarone is the preferred choice for preventing arterial fibrillation in patients who have undergone CABG.

Running head: EVIDENCE BASED NURSING ASSIGNMENT
Evidence based nursing assignment
Name of the student:
Name of the university:
Author Note:

1EVIDENCE BASED NURSING ASSIGNMENT
Table of Contents
Part C: 2
References: 4

2EVIDENCE BASED NURSING ASSIGNMENT
Part C:
In case of cardiac surgeries, arterial fibrillation is a common occurrence, which happens in
about 5 to 40% of the patients undergoing bypass graft surgery in the coronary arteries. This
particular phenomenon increases both the mortality and stay in the facility for the patients and is
one of the most detrimental postoperative complications in case of cardiovascular diseases.
Arterial fibrillation can be described as a supraventricular tachyarrhythmia, which brings about
uncoordinated arterial activation coupled with the process of successive deterioration of the
mechanical function associated with the entire procedure (Cadrin-Tourigny et al., 2017).
However, it has to be understood that arterial fibrillation is a phenomenon that has the potential
to cause extreme harm to the health and wellbeing of the patient concerned. Hence in order to
avoid or minimize the risk of arterial fibrillation different intervention techniques are utilized,
while in some cases beta blockers are used, in most cases amidarone is used (Cadrin-Tourigny et
al., 2017).
amioradone is much more favoured over the beta blockers in case of arterial fibrillation,
although in most cases the prescription bias prefers amioradone over the beta blockers, there are
some significant clinical reasons that support the amioradone over the beta blockers in case of
lowering the frequency of arterial fibrillation in the cardiac surgeries. According to the American
heart association, beta-blockers have previously been utilized in case of the arterial fibrillation as
the first line medication, whereas amioradone is used only in the cases where the patient is
unresponsive of the beta agonists, although the recent finding have proven the amioradone drug
to be far more superior than the beta agonists in treating and avoiding the arterial fibrillation
(Habibollahi et al., 2016). When considering the prophylaxis of arterial fibrillation in the patients

3EVIDENCE BASED NURSING ASSIGNMENT
undergoing bypass surgery, both classes of drugs, beta agonists and the amioradone groups of
drugs have been proved to be more or less similar in context of efficiency to treat the arterial
fibrillation. However, when the concepts of drug receptiveness and long term safety of the drugs
is considered, amiodarone is much more beneficial than the regular beta- blockers. There also are
significant pharmacokinetic differences between the amiodarone and beta agonist groups of
drugs. Different studies have suggested that characteristics like lipid solubility, bioavailability,
half life, distribution volume, binding of amino acids and elimination routes are some significant
variables that cause challenges in potential drug interaction and duration of beta blockade for the
beta agonist drugs, a problem that is absent when considering the amiodarone for the same
treatment (Mostafa et al., 2012).
Another highly important factor for the preference of amiodarone in case of treating arterial
fibrillation, is that in case of patients who never have had exposure to beta blocker usage in the
past do not find any benefit in using prophylactic beta blockers in case of arterial fibrillation.
Beta agonist withdrawal is one of the prime reasons behind the choice of amiodarone over beta
agonists, patients that are in the hyperadrenergic state react to bet agonists and the condition of
the patient deteriorates significantly in the postoperative state (Zirak et al., 2012). The post
operative complications associated with the beta agonist withdrawal can deteriorate the condition
if the patient in a very fast succession, hence in that of the patient who had undergone CABG,
the use of prophylactic post- operative amiodarone is known to be far more useful than the beta
agonists. Hence, amiodarone is used as the most useful and reliable prophylactic treatment for
arterial fibrillation and is chosen as the better alternative than the beta agonist drug here as well
(Zhu et al., 2012).

4EVIDENCE BASED NURSING ASSIGNMENT
References:
Cadrin-Tourigny, J., Shohoudi, A., Roy, D. and Khairy, P., 2017. Amiodarone and Beta-
Blockers in Patients With Heart Failure and Atrial Fibrillation. JACC: Heart Failure, 5(4),
pp.312-313.
Habibollahi, P., Jam, S.H., Vahdati, S.S., Baghi, H.M. and Amiri, H., 2016. Amiodaron in atrial
fibrillation: post coronary artery bypass graft. World journal of emergency medicine, 7(4), p.250.
Mostafa, A., EL-Haddad, M.A., Shenoy, M. and Tuliani, T., 2012. Atrial fibrillation post cardiac
bypass surgery. Avicenna journal of medicine, 2(3), p.65.
Zhu, J., Wang, C., Gao, D., Zhang, C., Zhang, Y., Lu, Y. and Gao, Y., 2012. Meta‐analysis of
amiodarone versus beta‐blocker as a prophylactic therapy against atrial fibrillation following
cardiac surgery. Internal medicine journal, 42(10), pp.1078-1087.
Zirak, N., Soltani, G., AbbasiMD, M., Hamadanchi, A., MoeinipourMD, A.A., Javan, H.,
Bagheri, R.K. and Shamloo, A.S., 2012. Prophylactic Effect of a Single Intravenous Dose of a
Combination of Digoxin, Hydrocortisone, and Amiodarone on Atrial Fibrillation after Off-Pump
Coronary Artery Bypasses Graft Surgery. OFFICIAL PUBLICATION OF THE IRANIAN
HEART ASSOCIATION, p.33.