Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University, Seoul, Korea.
Korean J Anesthesiol. 2010 Dec;59 Suppl(Suppl):S58-61. doi: 10.4097/kjae.2010.59.S.S58. Epub 2010 Dec 31.
Atrial fibrillation (AF) is the most common sustained tachyarrhythmia, and occurs in organic heart disease such as rheumatic, atherosclerotic and hypertensive heart disease. In recent studies, the sympathetic and parasympathetic nervous systems have been shown to have important roles in initiating paroxysmal AF. We report here a patient who developed paroxysmal AF that might be a result of an imbalance of the sympathetic-parasympathetic systems due to epidural anesthesia, and that was potentiated by pain with inadequate analgesia. A 69-year-old woman was scheduled for operation of a right-sided ankle fracture. Twenty minutes after epidural drug injection, paroxysmal AF occurred. Even after intravenous administration of esmolol and digoxin, AF continued. After transfer to the intensive care unit, her heart rate gradually decreased and AF disappeared. During perioperative anesthetic management, the proper preoperative prevention and intraoperative treatment are needed in AF high-risk patients.
心房颤动（AF）是最常见的持续性快速性心律失常，发生于器质性心脏病，如风湿性心脏病、动脉粥样硬化性心脏病和高血压性心脏病。最近的研究表明，交感神经和副交感神经系统在阵发性 AF 的发作中起重要作用。我们在此报告一例患者，其因硬膜外麻醉导致的交感-副交感神经系统失衡而发生阵发性 AF，疼痛伴镇痛不足使其加重。一位 69 岁女性拟行右侧踝关节骨折手术。硬膜外药物注射后 20 分钟，出现阵发性 AF。静脉注射艾司洛尔和地高辛后，AF 仍持续。转入重症监护病房后，她的心率逐渐下降，AF 消失。在围手术期麻醉管理中，AF 高危患者需要进行适当的术前预防和术中治疗。
