Bidar E, Bramer S, Maesen B, Maessen J G, Schotten U
Dept. Physiology and electrophysiology, Maastricht University Medical Centre.
Dept. Cardiothoracic surgery, Maastricht University Medical Centre.
J Atr Fibrillation. 2013 Apr 6;5(6):781. doi: 10.4022/jafib.781. eCollection 2013 Apr-May.
Atrial fibrillation occurring after cardiac surgery has been the subject of intensive research over the past decades. However, the incidence remains high, despite numerous preventive and treatment strategies. In addition, several reports show that the impact of post-operative atrial fibrillation (POAF) is high. It is an independent risk factor for mortality after several years. These findings make clear that the pathophysiology of POAF is not fully understood and POAF-associated risks to some extent might be underestimated. On the one hand, excessive triggers during the acute post operative phase after cardiac surgery might initiate AF even in atria with low vulnerability. On the other hand, many patients undergoing surgery have an atrial substrate at the time of operation promoting AF not only in the post-operative phase but also in the days and weeks thereafter. Progress in our understanding of the AF mechanisms in general has provided valuable insights into processes involved in atrial structural remodeling due to advanced age, hypertension, obesity, and congestive heart failure. These patient characteristics strongly contribute to cardiac disease, predict POAF and likely have an impact on the risk of thrombus formation in the weeks and months after cardiac surgery. For a better understanding of the mechanisms involved, it is important to not only recognize the occurrence of POAF by continuous monitoring after surgery, but also to identity the extent of atrial vulnerability to AF in these patients.
在过去几十年中，心脏手术后发生的心房颤动一直是深入研究的主题。然而，尽管有众多预防和治疗策略，其发病率仍然很高。此外，几份报告显示，术后心房颤动（POAF）的影响很大。它是数年后死亡的独立危险因素。这些发现清楚地表明，POAF的病理生理学尚未完全了解，并且POAF相关风险在一定程度上可能被低估。一方面，心脏手术后急性术后阶段的过度触发因素可能会引发房颤，即使在易损性较低的心房也是如此。另一方面，许多接受手术的患者在手术时就存在心房基质，这不仅会在术后阶段引发房颤，还会在之后的数天和数周内引发房颤。总体而言，我们对房颤机制的理解取得了进展，这为因高龄、高血压、肥胖和充血性心力衰竭导致的心房结构重塑过程提供了有价值的见解。这些患者特征对心脏病有很大影响，可预测POAF，并且可能对心脏手术后数周和数月内的血栓形成风险产生影响。为了更好地理解其中涉及的机制，不仅要通过术后持续监测识别POAF的发生，还要确定这些患者心房对房颤的易损程度。
