Turagam Mohit K, Mirza Mahek, Werner Paul H, Sra Jasbir, Kress David C, Tajik A Jamil, Jahangir Arshad
From the *Sheikh Khalifa bin Hamad Al Thani Center for Integrative Research on Cardiovascular Aging (CIRCA), Aurora University of Wisconsin Medical Group, Aurora Research Institute, Aurora Health Care, Milwaukee, WI; †University of Missouri-Columbia School of Medicine, Columbia, MO; ‡Aurora Medical Group - Cardiovascular and Thoracic Surgery, Aurora St. Luke's Medical Center, Milwaukee, WI; and §Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, WI.
Cardiol Rev. 2016 Mar-Apr;24(2):76-87. doi: 10.1097/CRD.0000000000000059.
Postoperative atrial fibrillation (PoAF), a common complication of cardiac surgery, contributes significantly to morbidity, mortality, and increasing healthcare costs. Despite advances in surgical and medical management, the overall incidence of PoAF has not changed significantly, partly because of the limited understanding of mechanisms underlying acute surgery-related factors, such as myocardial injury, inflammation, sympathetic activation, and oxidative stress, which play an important role in the initiation of PoAF, whereas a preexisting atrial substrate appears to be more important in the maintenance of this dysrhythmia. Thus, in a majority of patients, PoAF becomes a manifestation of an underlying arrhythmogenic substrate that is unmasked after acute surgical stress. As such, the ability to identify which patients have this proarrhythmic substrate and are, therefore, at high risk for developing AF postoperatively, is important for the improved selection for prophylactic interventions, closer monitoring for complications, and establishing the probability of AF in the long term. This review highlights the role of the underlying substrate in promoting PoAF, proposed mechanisms, and the potential role of serum biomarkers to identify patients at risk for PoAF.
术后房颤（PoAF）是心脏手术的常见并发症，对发病率、死亡率及不断增加的医疗费用有重大影响。尽管手术和药物治疗取得了进展，但PoAF的总体发病率并未显著改变，部分原因是对与手术相关的急性因素（如心肌损伤、炎症、交感神经激活和氧化应激）背后机制的了解有限，这些因素在PoAF的起始中起重要作用，而预先存在的心房基质在这种心律失常的维持中似乎更为重要。因此，在大多数患者中，PoAF成为急性手术应激后被揭示的潜在致心律失常基质的一种表现。因此，识别哪些患者具有这种促心律失常基质并因此术后发生房颤风险高的能力，对于改进预防性干预的选择、更密切监测并发症以及确定长期房颤的可能性很重要。本综述强调了潜在基质在促进PoAF中的作用、提出的机制以及血清生物标志物在识别PoAF风险患者中的潜在作用。
