INTRAOPERATIVE IDENTIFICATION OF CARDIAC PATIENTS AT RISK TO DEVELOP POSTOPERATIVE ATRIAL-FIBRILLATION
INTRAOPERATIVE IDENTIFICATION OF CARDIAC PATIENTS AT RISK TO DEVELOP POSTOPERATIVE ATRIAL-FIBRILLATION
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DOI：
10.1097/00000658-199105000-00002
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发表时间：
1991-05-01
影响因子：
9
通讯作者：
WELLS, R
中科院分区：
文献类型：
--
作者：
LOWE, JE;HENDRY, PJ;WELLS, R
术后心房颤动（AF）是心脏手术后11%-36%的患者发生的并发症，导致发病率和住院费用增加。 开发了一种新的电生理筛查试验，以识别术后AF发生风险的患者。该试验在50例平均年龄为59.6 ± 1.3岁的患者（43例男性和7例女性）中进行了验证，这些患者接受了冠状动脉旁路移植术，伴或不伴其他心脏外科手术。 在主动脉和静脉插管后，但在开始旁路之前，用25 μ A的双极探头刺激右心房中部3秒。 交流电流增加25 μ A，直到诱发AF或达到最大值200 μ A。 18例患者（36%）发生术后房颤，其中17例为可诱导房颤（敏感性= 0.94）。 在其余32例无房颤患者中，13例检测结果为阴性（特异性= 0.41）。 年龄和性别不是影响诱导的因素，尽管发生AF的患者比无AF的患者年龄大（63.6岁vs 57.3岁，p = 0.02）。 术后房颤患者在重症监护室的住院时间长于无房颤患者（3.6 vs 1.9天，p = 0.02）。 该试验的阴性预测值为0.93，阳性预测值为0.47。 这些数据表明，这种新的术中技术可用于识别术后房颤风险的患者。因此，预防性治疗可以仅针对那些术后房颤风险的患者。
Postoperative atrial fibrillation (AF) is a complication occurring in 11% to 36% of patients after cardiac operations, which results in increased morbidity and hospital costs. A new electrophysiologic screening test was developed to identify those patients at risk for development of postoperative AF. The test was validated in 50 patients (43 men and 7 women) with a mean age of 59.6 +/- 1.3 years who underwent coronary artery bypass grafting with or without other cardiac surgical procedures. After aortic and venous cannulation, but before initiation of bypass, the mid-right atrium was stimulated with a bipolar probe at 25-mu-A for 3 seconds. Alternating current was increased by 25-mu-A until AF was induced or up to a maximum of 200-mu-A. Postoperative AF occurred in 18 patients (36%), 17 of whom had inducible AF (sensitivity = 0.94). Of the remaining 32 AF-free patients, 13 had negative tests (specificity = 0.41). Age and sex were not factors affecting inducibility, although patients who developed AF were older than those who were AF free (63.6 versus 57.3 years, p = 0.02). Length of stay in the intensive care unit was longer for those with postoperative AF than for AF-free patients (3.6 versus 1.9 days, p = 0.02). The negative predictive value of the test was 0.93, and the positive value was 0.47. These data show that this new intraoperative technique may be used to identify patients at risk for postoperative AF. Prophylactic therapy can therefore be directed to only those patients at risk for postoperative AF.