Clay-Weinfeld Kirstan, Callans Melissa
Department of Cardiac Electrophysiology, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, PA, USA.
Department of Cardiac Electrophysiology, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, PA, USA; AGACNP Program, University of Pennsylvania School of Nursing, Philadelphia, 418 Curie Boulevard, Philadelphia, PA 19104, USA.
Crit Care Nurs Clin North Am. 2019 Sep;31(3):367-388. doi: 10.1016/j.cnc.2019.05.006. Epub 2019 Jul 5.
Cardiac arrhythmias are common after cardiac surgery and have profound sequelae. Bradycardias are typically transient and have reversible causes; however, persistent atrioventricular block is an indicator for permanent pacemaker implantation after valvular surgery. Transcatheter aortic valve surgery is associated with even higher rates of permanent pacemaker implantation. Atrial fibrillation, the most common postoperative arrhythmia, is associated with ischemic stroke, myocardial infarction, congestive heart failure, and short-term mortality. Ventricular arrhythmias have extremely high in-hospital mortality, as well as long-term mortality for those who survive the initial event. Implantable cardioverter-defibrillators have been shown to reduce long-term mortality for these patients.
心脏手术后心律失常很常见,且有严重的后遗症。心动过缓通常是短暂的,病因可逆;然而,持续性房室传导阻滞是瓣膜手术后植入永久性起搏器的指征。经导管主动脉瓣手术与更高的永久性起搏器植入率相关。心房颤动是最常见的术后心律失常,与缺血性卒中、心肌梗死、充血性心力衰竭及短期死亡率相关。室性心律失常的院内死亡率极高,对于在初始事件中存活下来的患者,长期死亡率也很高。植入式心律转复除颤器已被证明可降低这些患者的长期死亡率。