Atrial fibrillation after surgical intervention on the heart. Atrial fibrillation in severe and acute diseases.
Atrial fibrillation (AF) occurs frequently after open surgical intervention on the heart (approximately 25-50% of patients). When this happens, do at least 1-2 attempts to restore sinus rhythm. Anticoagulation with heparin or warfarin may be contraindicated, especially in the early postoperative period, so the rhythm of the patient is monitored closely to rapidly identify AF and to perform an electrical cardioversion within 48-hour window from the beginning. For monitoring heart rate in typical use cases, beta-blockers, diltiazem and verapamil.
When AF occurs in patients undergoing open heart surgery, before beginning treatment with antiarrhythmic drugs to help prevent further disruption of the rhythm. Usually used amiodarone as the drug was highly effective and well tolerated in the short-term treatment. When you begin treatment with amiodarone over FP, which arose after heart surgery, patients are informed that this drug will be cancelled in about 2-3 months. In those patients, which further breaks down the rhythm, to re-assess the need for antiarrhythmic drugs and, if necessary, choose the optimal antiarrhythmic medication for long term therapy in a particular patient.
Atrial fibrillation in severe and acute diseases.
AF often occurs in conditions of extreme systemic stressors such as shock and sepsis, as well as when the patient is on inotropic support drugs. In such circumstances patients may increase the level of catecholamines, and therefore heart rate, and cardiac rhythm can be very difficult to control.
Beta-blockers and redigeerimine calcium antagonists cannot be used if the patients receive medications to maintain BP.
Amiodarone, or even digoxin can to some extent slow down the heart rate, without causing excessive effect on AD. However, the use of amiodarone mean the probability of chemical cardioversion
As electrical cardioversion combined with antiarrhythmic drug and insulated can help control heart rate, to restore sinus rhythm. However, AF often recurs and if it recurs quickly, you have to put up with increased heart rate long enough to achieve control of the main process.