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Perioperative challenges of atrial fibrillation

机译：心房颤动的围手术期挑战

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Purpose of Review: The management of atrial fibrillation has seen marked changes in recent years. This is the result of better knowledge of the pathophysiology and risks factors for atrial fibrillation, better stratification for thromboembolic and bleeding risks, changing practices in anticoagulation management, and the development of new antiarrhythmic drugs. This article focuses on these new issues, with particular attention to their relevance in the perioperative period. RECENT FINDINGS: Improved understanding of the interaction between predisposing factors and the pathophysiological mechanisms of atrial fibrillation is changing management strategies. Preoperative identification of patients at risk for postoperative atrial fibrillation (POAF) is important so that measures such as ?-blockade may be introduced to prevent its occurrence. When POAF does occur, cardioversion is preferred in unstable patients and amiodarone is the most commonly used drug. Owing to the transient nature of POAF and excessive bleeding risk immediately postsurgery, anticoagulation should be used with caution in these patients. The perioperative management of patients on chronic oral anticoagulants is guided by weighing the risk of thromboembolic complications against the risk surgical bleeding. Risk stratification scoring systems and published guidelines facilitate decision-making. New oral anticoagulants offer potentially improved safety profiles over traditional agents; however, their optimal management in the perioperative period remains unknown. SUMMARY: Better knowledge of the pathophysiology of atrial fibrillation and improved awareness of the risks associated with this frequent arrhythmia are continuing to improve the management of patients with chronic atrial fibrillation and new-onset atrial fibrillation in the perioperative period. As with most complex disease processes, treatment decisions must be individualized for each patient and clinical context.
机译：审查目的：心房颤动的管理近年来已发生显着变化。这是由于对心房颤动的病理生理学和危险因素有了更深入的了解，对血栓栓塞和出血风险的更好分层，抗凝管理方法的改变以及新抗心律不齐药物的开发的结果。本文重点介绍这些新问题，尤其要注意它们在围手术期的相关性。最近的发现：对易感因素与房颤的病理生理机制之间相互作用的更好的了解正在改变管理策略。术前确定有术后房颤（POAF）风险的患者很重要，因此可以采用诸如β受体阻滞剂的措施来防止其发生。当确实发生POAF时，不稳定患者应首选心脏复律，而胺碘酮是最常用的药物。由于POAF的短暂性和术后立即出血的风险，在这些患者中应谨慎使用抗凝药物。通过权衡血栓栓塞并发症的风险与手术出血的风险，可以指导患者长期口服抗凝剂的围手术期管理。风险分层评分系统和已发布的指南有助于决策。新的口服抗凝剂与传统药物相比，可能会改善安全性;然而，他们在围手术期的最佳治疗方法仍然未知。摘要：对心房纤颤的病理生理学的更好了解以及与这种频繁的心律不齐相关的风险的认识不断提高，以改善围手术期慢性心房纤颤和新发房颤的患者的管理。与大多数复杂的疾病过程一样，治疗决策必须针对每个患者和临床情况进行个性化设置。

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