Post-operative atrial fibrillation: a maze of mechanisms.
Post-operative atrial fibrillation: a maze of mechanisms.
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DOI：
10.1093/europace/eur208
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发表时间：
2012-02
期刊：
影响因子：
--
通讯作者：
Schotten U
中科院分区：
文献类型：
--
作者：
Maesen B;Nijs J;Maessen J;Allessie M;Schotten U
术后心房颤动（POAF）是心脏手术最常见的并发症之一，也是患者发病率和住院时间延长的重要预测因素。这大大增加了住院费用。实验和临床研究都提供了引起POAF的病理生理因素，并表明POAF是“多因素”的。心律失常发生机制中的促进因素可分为手术干预引起的急性因素和与心脏结构性疾病和心脏老化有关的慢性因素。此外，一些致心律失常的机制在POAF的情况下特异性发生。例如，炎症和β -肾上腺素能激活已被证明在POAF中发挥重要作用，而这些机制在非手术房颤中不太重要。最近，有研究表明，心房纤维化和能够维持房颤的电生理底物的存在也会促进心律失常。这表明POAF与其他形式的房颤有一些共同的心律失常机制。POAF的临床环境为研究其机制提供了许多机会。在心脏手术期间，可以进行活组织检查和详细的电生理测量。此外，POAF的特定时间过程，以及心律失常的延迟发作和短暂性特征，也为其机制提供了重要的见解。本文就诱发因素与诱发POAF的电生理机制之间的相互作用及其治疗意义进行综述。
Post-operative atrial fibrillation (POAF) is one of the most frequent complications of cardiac surgery and an important predictor of patient morbidity as well as of prolonged hospitalization. It significantly increases costs for hospitalization. Insights into the pathophysiological factors causing POAF have been provided by both experimental and clinical investigations and show that POAF is ‘multi-factorial’. Facilitating factors in the mechanism of the arrhythmia can be classified as acute factors caused by the surgical intervention and chronic factors related to structural heart disease and ageing of the heart. Furthermore, some proarrhythmic mechanisms specifically occur in the setting of POAF. For example, inflammation and beta-adrenergic activation have been shown to play a prominent role in POAF, while these mechanisms are less important in non-surgical AF. More recently, it has been shown that atrial fibrosis and the presence of an electrophysiological substrate capable of maintaining AF also promote the arrhythmia, indicating that POAF has some proarrhythmic mechanisms in common with other forms of AF. The clinical setting of POAF offers numerous opportunities to study its mechanisms. During cardiac surgery, biopsies can be taken and detailed electrophysiological measurements can be performed. Furthermore, the specific time course of POAF, with the delayed onset and the transient character of the arrhythmia, also provides important insight into its mechanisms. This review discusses the mechanistic interaction between predisposing factors and the electrophysiological mechanisms resulting in POAF and their therapeutic implications.
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