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2012, Number 1

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Rev Mex Anest 2012; 35 (1)

Atrial fibrillation after cardiac surgery

Luna-Ortiz P, Martínez-Rosas M

Language: Spanish
References: 106
Page: 53-66
PDF size: 183.40 Kb.


ABSTRACT

Atrial fibrillation (AF) is the most common arrhythmia after cardiac surgery. The peak of incidence occurs between the second and third postoperative day. Postoperative AF is a risk factor for stroke, congestive heart failure and hemodynamic instability that increases the morbidity and mortality particularly, in elderly patients with left ventricular dysfunction. AF has been associated with prolonged hospitalization and increased costs. The etiology of this arrhythmia are not yet fully understood. This article reviews what is currently known about the pathophysiological mechanisms that trigger AF after cardiac surgery. The risk factors for postoperative AF in cardiac surgery are also revised. Additionally, recommendations are made on the management of patients with AF which include: control of heart rate and cardiac rhythm, the combined use of antiplatelet and anticoagulant therapy and use of antiarrhythmic drugs. Beta blockers can effectively prevent this arrhythmia so they are widely recommended if there is no contraindication. Sotalol may be the most effective of beta blockers. Amiodarone is useful when beta-blocker therapy is not possible or as additional prophylaxis in high risk patients. The use of other agents such as magnesium, calcium channels blockers, non-steroidal anti-inflammatory drugs, corticosteroids, and statins are mentioned. Finally, we include a protocol for postoperative AF management based on the most recent guidelines.


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