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首页> 外文期刊>Cardiovascular therapeutics >Prevention of atrial fibrillation in cardiac surgery: time to consider a multimodality pharmacological approach.
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Prevention of atrial fibrillation in cardiac surgery: time to consider a multimodality pharmacological approach.

机译：在心脏外科手术中预防心房颤动：是时候考虑采用多模式药理学方法了。

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Atrial fibrillation (AF) is very common within the first 5 days of cardiac surgery. It is associated with significant morbidity including stroke, ventricular arrhythmias, myocardial infarction, heart failure, acute kidney injury, prolonged hospital stay, and also short- and long-term mortality. The underlying mechanisms of developing AF after cardiac surgery are multifactorial; risk factors may include advanced age, withdrawal of beta-blockers and angiotensin-converting-enzyme inhibitors, valve surgery, obesity, increased left atrial size, and diastolic dysfunction. There are many pharmacological options in preventing AF, but none of them are effective for all patients and they all have significant limitations. Beta-blockers may reduce the incidence of AF by more than a third, but bradycardia, hypotension, or exacerbation of heart failure often limit their utility postoperatively. Recent evidence suggests that class III antiarrhythmic drugs, sotalol and amiodarone, are more effective than beta-blockers, but they both share similar hemodynamic side effects of beta-blockers. Magnesium, antiinflammatory drugs such as statins, omega fatty acids, and low-dose corticosteroids also have some efficacy and they have the advantages of not causing significant hemodynamic side effects. Data on effectiveness of calcium channel blockers, digoxin, alpha-2 agonists, sodium nitroprusside, and N-acetylcysteine are more limited. Because the pathogenesis of AF is multifactorial, a combination of drugs with different pharmacological actions may have additive or synergistic effect in preventing AF after cardiac surgery. Randomized controlled trials evaluating the effectiveness of a multimodality pharmacological approach in patients at high-risk of AF after cardiac surgery are needed.
机译：心房纤颤（AF）在心脏手术的前5天内非常普遍。它与包括脑卒中，室性心律不齐，心肌梗塞，心力衰竭，急性肾损伤，长期住院以及短期和长期死亡率在内的高发病率有关。心脏手术后发生房颤的潜在机制是多因素的。危险因素可能包括高龄，退出β-受体阻滞剂和血管紧张素转换酶抑制剂，瓣膜手术，肥胖，左心房增大和舒张功能障碍。预防房颤的药理学方法很多，但对所有患者均无效，而且都有明显的局限性。 β受体阻滞剂可以使房颤的发生率降低三分之一以上，但心动过缓，低血压或心力衰竭加重通常会限制术后的效用。最近的证据表明，III类抗心律不齐药物，索他洛尔和胺碘酮比β受体阻滞剂更有效，但它们都具有类似的β受体阻滞剂的血液动力学副作用。镁，抗炎药（如他汀类药物），欧米茄脂肪酸和低剂量皮质类固醇也有一定功效，它们的优点是不会引起明显的血液动力学副作用。关于钙通道阻滞剂，地高辛，α-2激动剂，硝普钠和N-乙酰半胱氨酸有效性的数据更为有限。由于房颤的发病机制是多因素的，因此具有不同药理作用的药物组合可能在心脏手术后预防房颤方面具有累加或协同作用。需要一项随机对照试验，评估一种多模式药理学方法对心脏手术后高危房颤患者的有效性。

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