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首页> 美国卫生研究院文献>Clinical Cardiology >Unexpected instant death following successful coronary artery bypass graft surgery (and other clinical settings): Atrial fibrillation quinidine procainamide et cetera and instant death
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Unexpected instant death following successful coronary artery bypass graft surgery (and other clinical settings): Atrial fibrillation quinidine procainamide et cetera and instant death

机译：成功进行冠状动脉搭桥手术后的意外死亡（和其他临床情况）：房颤奎尼丁普鲁卡因胺等以及死亡

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Primum non nocere. Atrial fibrillation (AF) occurs commonly following coronary artery bypass graft surgery, although new onset atrial fibrillation in this setting is usually transient. When AF reverts or is converted to sinus rhythm it is unlikely to recur, whether or not the patient takes preventive medication. As no benefit (and sometimes increased risk) associated with reduced mortality or morbidity in this setting has been reported for antiarrhythmic agents, standard treatment should consist of observation or control of ventricular response with an appropriate agent until AF relapses to sinus rhythm. If an antiarrhythmic agent, especially a class I agent, is used because of persistent or recurrent AF in the early postoperative period, heart rhythm should be monitored as long as the class I agent is administered and treatment initiated if an un‐dersirable rhythm develops. Atrial fibrillation in other clinical settings in patients with structural heart disease presents a more difficult management problem. Class I agents are reported to be associated with an increased risk of death, despite an efficacious effect of maintaining sinus rhythm. Amiodarone is reported to be well tolerated with respect to the cardiovascular system, but unacceptable noncardiac effects are reported. A safe amiodarone‐like agent is greatly needed. Atrial fibrillation in patients with no structural heart disease is not discussed in this presentation.
机译：初发非nocere。心房纤颤（AF）通常在冠状动脉搭桥手术后发生，尽管在这种情况下新发的房颤通常是短暂的。当房颤恢复或转换为窦律时，无论患者是否服用预防性药物，都不太可能复发。由于尚无抗心律不齐药物在这种情况下与降低死亡率或发病率相关的益处（有时会增加风险），因此标准治疗应包括观察或控制心室反应，并使用适当的药物直至房颤复发至窦性心律。如果在术后早期因持续性或复发性房颤而使用抗心律失常药物，尤其是I类药物，则应监测心律，只要给予I类药物并在出现不良心律时开始治疗。结构性心脏病患者在其他临床环境中的房颤出现了更困难的管理问题。据报道，尽管维持窦性心律有有效作用，但I类药物与死亡风险增加有关。据报道，胺碘酮对心血管系统具有很好的耐受性，但据报道，其对心脏的影响不可接受。非常需要安全的类胺碘酮类药物。没有结构性心脏病的患者的房颤未在本报告中讨论。

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