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. 2024 Feb;73(2):133-144.
doi: 10.1007/s00101-023-01375-0. Epub 2024 Jan 29.

[Perioperative atrial fibrillation : Diagnosis with underestimated relevance]

[Article in German]
Sebastian Adamowicz  1 , Erich Kilger  2 , Raphael Klarwein  2
Affiliations

[Perioperative atrial fibrillation : Diagnosis with underestimated relevance]

[Article in German]
Sebastian Adamowicz et al. Anaesthesiologie. 2024 Feb.

Abstract
in English, German

Atrial fibrillation (AF) is the most common cardiac arrhythmia in adults, both in general and perioperatively and is associated with significant morbidity and mortality. The age of the patients is a major risk factor. The prevalence of AF in noncardiac surgery (NCS) varies widely from 0.4% to 30% and for cardiac surgery, especially major combined procedures, up to approximately 50%. Ectopic excitation centers and reentry mechanisms at the atrial level are favored as the main process of uncoordinated electrical atrial activity. The loss of atrial contraction can lead to a reduction in cardiac output of up to 20-25%. The increased risk of thromboembolism due to AF extends beyond the perioperative period. Medication-based prevention strategies have not yet gained widespread acceptance. Treatment strategies include frequency and rhythm control as well as the avoidance of thromboembolisms through anticoagulation.

Vorhofflimmern (VHF) ist i. Allg. und auch perioperativ die häufigste Herzrhythmusstörung bei Erwachsenen und mit einer substanziellen Morbidität und Letalität assoziiert. Ein wesentlicher Risikofaktor ist das Alter der Patient*innen. Die Prävalenz des VHF bei nichtkardiochirurgischen Eingriffen (NCS) wird zwischen 0,4 und 30 % sowie bei kardiochirurgischen Operationen, insbesondere großen Kombinationseingriffen, bis ca. 50 % angegeben . Ektope Erregungszentren und Reentrymechanismen auf Vorhofebene werden als führende Prozesse der unkoordinierten elektrischen Vorhofaktivität favorisiert. Durch den Verlust der atrialen Kontraktion kann sich das Herzzeitvolumen (HZV) um bis zu 20–25 % reduzieren. Das aufgrund des VHF erhöhte Thromboembolierisiko hält über die Operation hinaus an. Medikamentöse Präventionsstrategien konnten sich noch nicht durchsetzen. Therapeutische Strategien umfassen die Frequenz- und Rhythmuskontrolle sowie die Vermeidung von Thromboembolien durch Antikoagulation.

Keywords: Anesthesia; Cardiac arrhythmias; Cardiac output; Outcome; Thromboembolism.

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References

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