[AF-FORUM] 21SE 房颤术后发生慢室率－Rondon 医师

[AF Symposium]

Prabhakar C 医生：    因为在我们国家有许多关于风湿 
性二尖瓣狭窄和接受二尖瓣水平修复的RV手术及二尖 
瓣、主动脉瓣联合置换术，以及换瓣术后行迷宫手术 
恢复窦律后不久房颤复发并时有慢心率表现的病例讨 
论，所以我有幸回答您的问题。我们建议在上述病例 
中评估以下三方面因素来制定治疗措施：1－心超测 
量左房，因为在左房直径大于55 mm的情况下，几乎不 
可能恢复窦律。2－评估EF、确认LV直径，因为观察发 
现收缩期LV直径大于60 mm的患者预后较差，且需要更 
多的支持治疗才能离开ICU。在上述情况下，我们推荐 
在左室、右室及左房置入起搏电极达到术后的左右心 
室再同步作为预防。如果效果好，我们考虑置入永久 
起搏装置。3－评估住院期间发生短暂窦律事件的机 
会，评估引发房颤的机制（使用术后动态心电图监 
测），因为通过起搏抑制房颤原理可能会利用房颤转 
复机制。重要的是确认术后心肌的情况，由此确定该 
患者是否适合利用外部装置支持恢复窦律，尽量延长 
窦律时间、维持良好的左室功能。 Mauricio Rondón医师 
Hospital Universitario ，加拉卡斯--
Dr.Sergio  Dubner

科委会主席

Dr.Edgardo  Schapachnik

组委会主席

  张欣  译  王玲洁校



  21SE Post operative AF with slow ventricular rate. Dr. Rondon

Dr. Prabhakar C,I dare to answer you, since in our country  
(Venezuela) we have quite  some casuistics on rheumatic mitral valve  
stenosis, and on the patients who undergo RV surgery with prosthesis  
at mitral level, and on occasions a double replacement, which  
includes the aorta; and who in a post-operative situation and with  
Maze surgery return to sinus  rhythm, and within days they present  
again AF with slow response on  occasions. We suggest in these cases  
to assess 3 very important things to decide the management for these  
patients.1-Echocardiogram to measure the left atrium, since in cases  
with  diameters greater than 55 mm, it is almost impossible to  
maintain sinus rhythm.2-Assessing EF and verifying LV diameters,  
since the cases with systolic diameters greater than 60 mm have a bad  
prognosis in follow up and will require a lot of support to leave the  
ICU. In these cases we recommend as prophylaxis, to place the pacing  
electrodes in the LV, RV and LA, to attempt post-operative  
resynchronization, and if the result is good, we consider implanting  
a permanent device.3-Evaluating the chance of transitory events of  
sinus rhythm, during  hospitalization and evaluating which mechanism  
triggers AF (with post- operative Holter) since there could be a  
chance of using reversion  mechanisms of post-operative AF with  
pacemaking antifibrillatory algorithms.The important thing is  
verifying the condition of the myocardium in the post-operative  
period and deciding if the patient is a candidate for other  
mechanisms of external support to try to maintain her in sinus rhythm  
as long as possible and with a good LV function.  Dr  Mauricio  
RondónHospital Universitario de Caracas--Dr. Sergio DubnerPresident  
of Scientific CommitteeDr. Edgardo SchapachnikPresident of Steering  
Committee
--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee