Atrial fibrillation is a frequent postoperative complication in cardiac surgery. The condition may be difficult for clinicians to differentiate when the patient has a rapid ventricular response (>150/min), among patients with a preexisting bundle branch block, and during monitoring of surface electrocardiographic (ECG) leads.

Atrial electrograms can be helpful in proper diagnosis of atrial fibrillation in this population when the atrial pacing wires are still in place.

A unit-based policy or procedure should be established to provide guidance for staff nurses on the cardiac surgery unit. Be sure to include the cardiac surgeons in the process. Information that should be included:

Training for nurses also should include evaluation of the atrial electrogram in comparison with the surface ECG tracing to identify atrial arrythmias. Including the surgery residents and fellows in the training will foster collaborative practice and trust among members of the team.

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