Willich T, Hammwöhner M, Goette A
Medizinische Klinik II, St. Vincenz Krankenhaus Paderborn, Am Busdorf 2, 33098, Paderborn, Deutschland.
Med Klin Intensivmed Notfmed. 2012 Jun;107(5):368-76. doi: 10.1007/s00063-012-0082-5. Epub 2012 Jun 13.
Atrial fibrillation (AF) is the most common form of arrhythmia in the intensive care unit (ICU) and is associated with increased mortality. A total of five types of AF can be distinguished: initially diagnosed, paroxysmal, persistent, long-standing persistent and permanent AF. In addition to the initial treatment, antithrombotic therapy, rate and rhythm management can be used. The treatment of comorbidities is part of the patient management and for patients with increased risk of thromboembolic events anticoagulation is recommended. The simplest risk assessment scheme is the CHADS score. In the acute setting rate control is important. Direct current cardioversion is urgently recommended for patients with AF when hemodynamic instability is present even in patients with AF and pre-excitation in Wolff-Parkinson-White syndrome. Pharmacological cardioversion may be considered in patients with AF when hemodynamic stability is present. When choosing the antiarrhythmic agent for critically ill patients only amiodarone can be considered with some exceptions due to the specific contraindications.
心房颤动（AF）是重症监护病房（ICU）中最常见的心律失常形式，且与死亡率增加相关。AF总共可分为五种类型：初发诊断型、阵发性、持续性、长期持续性和永久性AF。除初始治疗外，还可采用抗栓治疗、心率和节律管理。合并症的治疗是患者管理的一部分，对于血栓栓塞事件风险增加的患者，建议进行抗凝治疗。最简单的风险评估方案是CHADS评分。在急性情况下，心率控制很重要。对于存在血流动力学不稳定的AF患者，即使是患有预激综合征的AF患者，紧急建议进行直流电复律。当血流动力学稳定时，AF患者可考虑药物复律。在为重症患者选择抗心律失常药物时，由于存在特定禁忌证，一般仅可考虑胺碘酮，某些情况除外。
