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2012, Número 1

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Rev Mex Anest 2012; 35 (1)


Fibrilación auricular después de cirugía cardíaca

Luna-Ortiz P, Martínez-Rosas M

Idioma: Español
Referencias bibliográficas: 106
Paginas: 53-66
Archivo PDF: 183.40 Kb.


RESUMEN

La fibrilación auricular (FA) es la arritmia más común después de la cirugía cardíaca. La mayor incidencia ocurre entre el segundo y tercer día del postoperatorio. La FA postoperatoria representa un factor de riesgo de accidente cerebrovascular, de falla cardíaca congestiva e inestabilidad hemodinámica que incrementa la morbimortalidad; además de prolongar la estancia en el hospital, particularmente en pacientes ancianos y con disfunción ventricular izquierda. La etiología de esta arritmia y los factores desencadenantes aún no son completamente entendidos. En este artículo revisamos lo que se conoce en la actualidad sobre los mecanismos fisiopatológicos que desencadenan FA después de cirugía cardíaca. También se estudian los factores de riesgo de FA en el postoperatorio de cirugía cardíaca. Adicionalmente se hacen recomendaciones sobre el manejo de los pacientes con FA, las cuales incluyen el control de la frecuencia y el ritmo cardíaco; el uso combinado de la terapia antiplaquetaria y anticoagulante y el uso de fármacos antiarrítmicos. En este sentido cabe resaltar que los betabloqueadores pueden prevenir efectivamente esta arritmia por lo que se recomiendan ampliamente si no existe contraindicación. El sotalol parece ser el más efectivo de ellos. La amiodarona es útil cuando la terapia con betabloqueadores no es posible, o bien se puede usar como profilaxis adicional en pacientes de alto riesgo. Se mencionan el uso de otros agentes como magnesio, bloqueadores del canal de Ca2+, AAINES, corticosteroides y estatinas. Se incluye un protocolo de manejo de la FA postoperatoria basado en las guías más recientes.


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