[Perioperative atrial fibrillation : Diagnosis with underestimated relevance].

Die Anaesthesiologie Pub Date : 2024-02-01 Epub Date: 2024-01-29 DOI:10.1007/s00101-023-01375-0
Sebastian Adamowicz, Erich Kilger, Raphael Klarwein
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Abstract

Atrial fibrillation (AF) is the most common cardiac arrhythmia in adults, both in general and perioperatively and is associated with significant morbidity and mortality. The age of the patients is a major risk factor. The prevalence of AF in noncardiac surgery (NCS) varies widely from 0.4% to 30% and for cardiac surgery, especially major combined procedures, up to approximately 50%. Ectopic excitation centers and reentry mechanisms at the atrial level are favored as the main process of uncoordinated electrical atrial activity. The loss of atrial contraction can lead to a reduction in cardiac output of up to 20-25%. The increased risk of thromboembolism due to AF extends beyond the perioperative period. Medication-based prevention strategies have not yet gained widespread acceptance. Treatment strategies include frequency and rhythm control as well as the avoidance of thromboembolisms through anticoagulation.

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[围手术期心房颤动:相关性被低估的诊断]。
心房颤动(房颤)是成年人最常见的心律失常,无论是在一般情况下还是在围手术期,它都与严重的发病率和死亡率相关。患者的年龄是一个主要的风险因素。心房颤动在非心脏手术(NCS)中的发病率差别很大,从 0.4% 到 30%,而在心脏手术(尤其是大型联合手术)中的发病率则高达约 50%。心房水平的异位兴奋中心和再入机制被认为是心房不协调电活动的主要过程。心房收缩功能的丧失可导致心输出量减少高达 20%-25%。心房颤动导致的血栓栓塞风险增加已超越了围手术期。以药物为基础的预防策略尚未得到广泛接受。治疗策略包括控制频率和心律以及通过抗凝避免血栓栓塞。
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