Atrial fibrillation after coronary artery bypass surgery: Possibilities of prevention

Abstract

Atrial fibrillation occurs as a frequent complication after cardiac interventions. It can be found in 5% of all surgical patients, and it is far more common in cardiac (10% - 65% of patients) than in non-cardiac procedures. In a number of patients it remains asymptomatic, but may be accompanied by very severe symptoms of hypotension, heart failure, syncope, systemic or pulmonary embolism, perioperative myocardial infarction, cerebrovascular insult and increased operative mortality. Patients whose postoperative course is complicated by atrial fibrillation require longer hospitalization. Possible predisposing factors of this arrhythmia are numerous and are associated with surgery, extensive coronary heart disease and revascularization, and preoperative diseases. According to the recommendations of the European Society of Cardiology orally applied beta-blocker, amiodarone and sotalol can be used for prophylaxis of atrial fibrillation. Following the recommendations, treatment of postoperative atrial fibrillation should include beta-blockers, amiodarone, and in patients with heart failure and left ventricular dysfunction, digoxin. Due to the increased risk of stroke, an anticoagulant protection is necessary. Many studies have been conducted with results supporting the prophylactic use of amiodarone and beta-blockers, while the treatment with new agents such as magnesium, statins, omega-3 fatty acids and inhibitors of the renin-angiotensin-aldosterone system is still being investigated.Atrijalna fibrilacija je cesta komplikacija hirurskih intervencija. Belezi se kod 5% svih operisanih bolesnika, ali mnogo cesce kod osoba koje su podvrgnute kardiohirurskim operacijama (10-65% bolesnika) nego drugim hirurskim zahvatima. Kod nekih bolesnika ona je asimptomatska, ali moze biti pracena i teskom hipotenzijom, insuficijencijom srca, sinkopama, sistemskim ili embolijama pluca, perioperacionim infarktom miokarda, cerebrovaskularnim insultom i povecanjem hirurskog mortaliteta. Bolesnicima ciji je postoperacioni tok komplikovan atrijalnom fibrilacijom potrebno je duze bolnicko lecenje. Moguci predisponirajuci cinioci ove aritmije su brojni i povezani sa samom hirurskom intervencijom, rasirenoscu koronarne bolesti i obimom revaskularizacije, kao i preoperacionim oboljenjima. Za profilaksu atrijalne fibrilacije se, prema preporukama Evropskog udruzenja kardiologa, mogu koristiti oralno primenjen beta- bloker, amjodaron i sotalol. Rukovodeci se preporukama, terapija atrijalne fibrilacije posle operacije vrsi se beta-blokerima, amjodaronom, a kod bolesnika s insuficijencijom srca i disfunkcijom leve komore i digoksinom. Mnoge studije govore u prilog profilaktickoj primeni amjodarona i beta-blokera, dok se primena novih agensa, kao sto su magnezijum, statini, omega- 3 masne kiseline i inhibitori sistema renin- angiotenzin- aldosteron, jos ispituje.