Department of Intensive Care Medicine, Royal Perth Hospital and School of Population Health, University of Western Australia, Perth, WA 6000, Australia.
Cardiovasc Ther. 2010 Spring;28(1):59-65. doi: 10.1111/j.1755-5922.2009.00117.x.
Atrial fibrillation (AF) is very common within the first 5 days of cardiac surgery. It is associated with significant morbidity including stroke, ventricular arrhythmias, myocardial infarction, heart failure, acute kidney injury, prolonged hospital stay, and also short- and long-term mortality. The underlying mechanisms of developing AF after cardiac surgery are multifactorial; risk factors may include advanced age, withdrawal of beta-blockers and angiotensin-converting-enzyme inhibitors, valve surgery, obesity, increased left atrial size, and diastolic dysfunction. There are many pharmacological options in preventing AF, but none of them are effective for all patients and they all have significant limitations. Beta-blockers may reduce the incidence of AF by more than a third, but bradycardia, hypotension, or exacerbation of heart failure often limit their utility postoperatively. Recent evidence suggests that class III antiarrhythmic drugs, sotalol and amiodarone, are more effective than beta-blockers, but they both share similar hemodynamic side effects of beta-blockers. Magnesium, antiinflammatory drugs such as statins, omega fatty acids, and low-dose corticosteroids also have some efficacy and they have the advantages of not causing significant hemodynamic side effects. Data on effectiveness of calcium channel blockers, digoxin, alpha-2 agonists, sodium nitroprusside, and N-acetylcysteine are more limited. Because the pathogenesis of AF is multifactorial, a combination of drugs with different pharmacological actions may have additive or synergistic effect in preventing AF after cardiac surgery. Randomized controlled trials evaluating the effectiveness of a multimodality pharmacological approach in patients at high-risk of AF after cardiac surgery are needed.
心房颤动（AF）在心脏手术后的前 5 天非常常见。它与重大发病率相关，包括中风、室性心律失常、心肌梗死、心力衰竭、急性肾损伤、住院时间延长，以及短期和长期死亡率增加。心脏手术后发生 AF 的潜在机制是多因素的；危险因素可能包括年龄较大、停用β受体阻滞剂和血管紧张素转换酶抑制剂、瓣膜手术、肥胖、左心房增大和舒张功能障碍。有许多药物预防 AF 的选择，但没有一种对所有患者都有效，而且它们都有显著的局限性。β受体阻滞剂可使 AF 的发生率降低三分之一以上，但心动过缓、低血压或心力衰竭加重常限制其术后应用。最近的证据表明，III 类抗心律失常药物索他洛尔和胺碘酮比β受体阻滞剂更有效，但它们都具有与β受体阻滞剂相似的血液动力学副作用。镁、他汀类等抗炎药物、ω 脂肪酸和低剂量皮质类固醇也有一定疗效，并且它们不会引起明显的血液动力学副作用。钙通道阻滞剂、地高辛、α-2 激动剂、硝普钠和 N-乙酰半胱氨酸的有效性数据更为有限。由于 AF 的发病机制是多因素的，因此具有不同药理作用的药物联合使用可能对预防心脏手术后 AF 具有相加或协同作用。需要进行随机对照试验来评估心脏手术后 AF 高危患者的多模式药物治疗方法的有效性。
