不整脈 : 予防のための術中・術後管理と治療 (特集 胸部外科領域における合併症予防のための周術期管理) -- (呼吸器領域)

: Perioperative/postoperative atrial fibrillation and flutter( POAF) is one of the common complications after pulmonary resection and the frequency is reported as 12.6% according to Society of Thoracic Surgeons general thoracic surgery database. We usually observed POAF 2~3 day after operation. While the etiology remains uncertain, the left atrial overload by the refilling from the 3rd space or systemic inflammation after surgery could raise this complication in addition to the right atrial overload following pulmonary resection and postoperative hypoxia status. Several Na channel blockers, β-blockers, and Ca blockers, which are the key drugs, are currently available to control the rate and rhythm. Anticoagulant therapy using warfarin or novel oral anticoagulants should be considered in patients with prolonged POAF more than 48 hours to prevent the thromboembolism. There are a few clinical trials to prevent POAF so far, while further investigation is necessary.