Groeben H, Böttiger B W, Heine J
Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Germany.
Anasthesiol Intensivmed Notfallmed Schmerzther. 2003 Sep;38(9):600-4. doi: 10.1055/s-2003-41856.
Atrial fibrillation is the most common clinically relevant arrhythmia. Anesthesiologists will be faced with atrial fibrillation of new or undetermined onset at their preoperative evaluation of patients as well as during intra- and post operative care. Because of fast electrophysical and structural remodeling, atrial fibrillation tends to persist and reoccur after successful conversion with increasing time of duration. Therefore, atrial fibrillation with an onset of less than 48 hours should be attempt to convert as soon as diagnostic work up has been made and possible causes have been corrected. New developments of electrophysiological and pharmacological treatment have improved the short term success rate of cardioversion. Further developments might give even more specific treatment options for the individual patient. In contrast, for treatment of chronic atrial fibrillation rate control therapy and thromboembolic prophylaxes seems to be more advisable with a lower risk of drug side effects and stroke. Anticoagulation should be initiated not later than 48 hours after the onset of atrial fibrillation. Finally, the development of implantable devices for the treatment of atrial fibrillation seem to be a promising therapeutic option for patients in end-stage heart diseases.
心房颤动是临床上最常见的相关心律失常。麻醉医生在术前评估患者以及术中、术后护理过程中，都会遇到新发或病因不明的心房颤动。由于快速的电生理和结构重塑，心房颤动在成功转复后往往会随着持续时间的增加而持续存在并复发。因此，对于发作时间少于48小时的心房颤动，一旦完成诊断性检查并纠正了可能的病因，就应尽快尝试转复。电生理和药物治疗的新进展提高了转复的短期成功率。进一步的发展可能会为个体患者提供更具针对性的治疗选择。相比之下，对于慢性心房颤动的治疗，心率控制疗法和血栓栓塞预防似乎更可取，药物副作用和中风的风险较低。抗凝治疗应在心房颤动发作后不迟于48小时开始。最后，用于治疗心房颤动的植入式设备的发展似乎是终末期心脏病患者一种有前景的治疗选择。
