Atrial Fibrillation after Cardiac Surgery by Jonathan S. Steinberg

By Jonathan S. Steinberg

Cardiac surgical procedure is played on millions of sufferers a 12 months, and will have a major invaluable impression at the results of sufferers with coronary and valvular middle ailments. regardless of the favorable restoration of such a lot sufferers, a few can have their post-operative interval interrupted via the improvement of atrial traumatic inflammation, with a number of strength issues together with stroke. excessive possibility subgroups may possibly enhance atrial traumatic inflammation in additional than part of instances, and sometimes regardless of competitive prophylactic measures. remedy of atrial traumatic inflammation and its aftermath may also upload days to the sanatorium remain of the cardiac surgical sufferer. In an period of competitive fee slicing and optimization of usage of well-being care assets, the monetary effect of this arrhythmic trouble might be huge, immense.
Experimental stories have resulted in a better figuring out of the mechanism of atrial traumatic inflammation and strength precipitating components within the cardiac surgical sufferer. Prophylactic efforts with beta-blockers, antiarrhythmic medications and atrial pacing are getting used, or are being investigated in medical trials. New tools of attaining recommended cardioversion with minimum disruption of sufferer care, and prevention of the thromboembolic problems of atrial traumatic inflammation, also are vital healing tasks. this article is designed to relief wellbeing and fitness care execs within the therapy in their sufferers in the restoration interval after cardiac surgical procedure, and to instigate extra learn efforts to restrict the incidence of, and the problems following, this tenacious postoperative arrhythmia.

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48. Cox JL. A perspective of postoperative atrial fibrillation in cardiac operations. Ann Thorac Surg 1993;56:405-409. 49. Kolvekar S, D'Souza A, Akhatar P, Reek C, Garratt C, Spyt T. Role of atrial ischaemia in development of atrial fibrillation following coronary artery bypass surgery. Eur J Cardio-Thor Surg 1997;11:70-75. 34 50. Mendcs LS, Connelly GP, McKenney PA, et al. Right coronary artery stenosis: an independent predictor of atrial fibrillation after coronary artery bypass surgery. J Am Coll Cardiol 1995;25:198-202.

3. Creswell LL, Schuessler RB, Rosenbloom M, Cox JL. Hazards of postoperative atrial arrhythmias. Ann Thorac Surg 1993:56;539-545. 4. Mathew JP, Parks R, Savino JS, et al. Atrial fibrillation following coronary artery bypass graft surgery. JAMA 1996;274:300-306. 5. Feinberg WM, Blackshear JL, Laupacis A, Kronmal R, Hart RG. Prevalence, age distribution, and gender of patients with atrial fibrillation; analysis and implications. Arch Int Med 1995;155:469-473. 6. Benjamin EJ, Levy D, Vaziri SM, D'Agostino RB, Belanger AJ, Wolf PA.

Atrial septal defect closure, for example, is complicated by AF in approximately 15% of cases [3]. Following the Fontan procedure, the prevalence is somewhat higher [26,27]. These overall lower incidences of AF occur despite extensive atrial surgery, and may relate to a more normal atrial ultrastructure. The younger age, lower prevalence of concomitant coronary disease, and less atrial fibrosis and/or dilatation all probably protect against postoperative AF in these patients. That AF appears to be less common in small hearts has been substantiated in veterinary studies [28], and presumably relates to a critical amount of atrial myocardium large enough to support the multiple simultaneous reentry circuits necessary to maintain AF.

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