Department of Pharmacy Practice, Creighton university School of Pharmacy and Health Professions, Omaha, Nebraska 68178, USA.
Pharmacotherapy. 2010 Jul;30(7):749, 274e-318e. doi: 10.1592/phco.30.7.749.
Postoperative atrial fibrillation (POAF) is a frequent complication of cardiac surgery that increases patient morbidity, length of stay, and hospital costs. A substantial body of evidence exists evaluating various pharmacologic and nonpharmacologic methods to decrease the occurrence of POAF in an effort to decrease its burden on the health care system. Evidence-based guidelines support the use of beta-blockers as standard prophylaxis of POAF in patients undergoing cardiac surgery. Traditional prophylactic therapy for POAF targets the sympathetic nervous system, refractory period, and atrial conduction. However, associations between the development of POAF and the inflammatory process, oxidative stress, and atrial remodeling have prompted the investigation of novel therapies targeting these processes. To evaluate the role of pharmacologic strategies beyond beta-blockers in the prevention of POAF, we conducted a search of the PubMed database to identify studies published from 1950-February 2009. Emphasis was placed on how these therapies could be used in patients intolerant to beta-blockers or as additive therapy in high-risk patients. We found that sufficient evidence exists to recommend the use of amiodarone, sotalol, and possibly magnesium as monotherapy in patients unable to take beta-blockers or as add-on therapy for the prevention of POAF. Currently, available evidence does not support the use of propafenone, procainamide, digoxin, thiazolidinediones, triiodothyronine, or calcium channel blockers in the prevention of POAF. Preliminary evidence suggests that dofetilide, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins), nonsteroidal antiinflammatory drugs, corticosteroids, omega-3 fatty acids, ascorbic acid, N-acetylcysteine, and sodium nitroprusside may be effective in preventing POAF. Additional large-scale, adequately powered clinical studies are needed to determine the benefit of these agents before they can be considered for routine use.
术后心房颤动（POAF）是心脏手术后的一种常见并发症，会增加患者的发病率、住院时间和医疗费用。有大量证据评估了各种药物和非药物方法，以减少 POAF 的发生，从而减轻其对医疗保健系统的负担。循证指南支持使用β受体阻滞剂作为心脏手术后患者 POAF 的标准预防。POAF 的传统预防治疗针对交感神经系统、不应期和心房传导。然而，POAF 的发展与炎症过程、氧化应激和心房重构之间的关联促使人们研究针对这些过程的新疗法。为了评估β受体阻滞剂以外的药物策略在预防 POAF 中的作用，我们在 PubMed 数据库中进行了搜索，以确定从 1950 年 2 月至 2009 年发表的研究。重点是这些疗法如何用于不能耐受β受体阻滞剂的患者或作为高危患者的附加治疗。我们发现，有足够的证据推荐使用胺碘酮、索他洛尔和可能的镁作为不能服用β受体阻滞剂的患者的单一疗法或预防 POAF 的附加疗法。目前，现有证据不支持普罗帕酮、普鲁卡因胺、地高辛、噻唑烷二酮、三碘甲状腺原氨酸或钙通道阻滞剂用于预防 POAF。初步证据表明，多非利特、血管紧张素转换酶抑制剂、血管紧张素 II 受体阻滞剂、3-羟基-3-甲基戊二酰辅酶 A 还原酶抑制剂（他汀类药物）、非甾体抗炎药、皮质类固醇、ω-3 脂肪酸、抗坏血酸、N-乙酰半胱氨酸和亚硝基铁氰化钠可能有效预防 POAF。需要进一步进行大规模、充分的临床研究，以确定这些药物的益处，然后才能考虑常规使用。
