Srpski arhiv za celokupno lekarstvo 2012 Volume 140, Issue 7-8, Pages: 521-527
https://doi.org/10.2298/SARH1208521O
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Atrial fibrillation after coronary artery bypass surgery: Possibilities of prevention
Obrenović-Kirćanski Biljana (Medicinski fakultet, Beograd + Klinika za kardiologiju, Klinički centar Srbije, Beograd)
Orbović Bojana (Klinika za kardiologiju, Klinički centar Srbije, Beograd)
Vraneš Mile (Medicinski fakultet, Beograd + Klinika za kardiohirurgiju, Klinički centar Srbije, Beograd)
Parapid Biljana (Klinika za kardiologiju, Klinički centar Srbije, Beograd)
Kovačević-Kostić Nataša (Centar za anesteziju i reanimatologiju, Klinički centar Srbije, Beograd)
Velinović Miloš (Medicinski fakultet, Beograd + Klinika za kardiohirurgiju, Klinički centar Srbije, Beograd)
Ristić Stana (Klinika za kardiohirurgiju, Klinički centar Srbije, Beograd)
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.
Keywords: postoperative atrial fibrillation, myocardial revascularization, amiodarone