Burke Scott W, Solomon Allen J
Division of Cardiology, Department of Medicine, Georgetown University Medical Center, Washington, DC 20007, USA.
Am J Cardiovasc Drugs. 2003;3(2):95-100. doi: 10.2165/00129784-200303020-00003.
Atrial fibrillation in patients undergoing cardiovascular surgery is a common problem, occurring in 25-50% of patients. Older patients and those with a prior history of atrial fibrillation are at highest risk, as are those patients in whom preoperative treatment with beta-blockers has been discontinued. The immediate sequelae of this common complication include hemodynamic instability and congestive heart failure with long-term consequences including thromboembolic phenomena and increased cost and length of hospitalization. beta-Blockers, amiodarone, and sotalol have all been shown to decrease the incidence of postoperative atrial fibrillation, but their use may be limited by their adverse effects. Other agents have some promise as prophylactic agents, but need further verification. Biatrial pacing has been shown to be effective, especially when beta-blockers are used simultaneously. The goals for the treatment of atrial fibrillation include maintaining hemodynamic stability, controlling ventricular rate, preventing thromboembolic complications, and restoring sinus rhythm. The most effective strategy for the prevention of atrial fibrillation is to identify the highest-risk patients and target them for prophylaxis with beta-blockers, amiodarone, sotalol or pacing.
接受心血管手术的患者发生心房颤动是一个常见问题，发生率为25%至50%。老年患者以及有房颤既往史的患者风险最高，术前停用β受体阻滞剂治疗的患者也是如此。这种常见并发症的直接后果包括血流动力学不稳定和充血性心力衰竭，长期后果包括血栓栓塞现象以及住院费用增加和住院时间延长。β受体阻滞剂、胺碘酮和索他洛尔均已被证明可降低术后房颤的发生率，但其使用可能会受到不良反应的限制。其他药物作为预防药物有一定前景，但需要进一步验证。双心房起搏已被证明是有效的，尤其是在同时使用β受体阻滞剂时。房颤治疗的目标包括维持血流动力学稳定、控制心室率、预防血栓栓塞并发症以及恢复窦性心律。预防房颤最有效的策略是识别高危患者，并针对他们使用β受体阻滞剂、胺碘酮、索他洛尔或起搏进行预防。
