Anest. intenziv. Med. 2026;37(1):28-35 | DOI: 10.36290/aim.2026.011

Levá síň a fibrilace síní u kriticky nemocných: od echokardiografie k terapiiReview Article

Tencer T.1, 2, Waldauf P.3, Balik M.4
1 Department of Anaesthesiology, Resuscitation and Intensive Care Medicine, Motol University Hospital and Second Faculty of Medicine, Charles University, Prague
2 Third Faculty of Medicine, Charles University, Prague
3 Department of Anaesthesiology and Resuscitation, Kralovske Vinohrady University Hospital, Third Faculty of Medicine, Charles University, Prague
4 Department of Anaesthesiology, Resuscitation and Intensive Care Medicine, General University Hospital and First Faculty of Medicine, Charles University, Prague

Nově vzniklá fibrilace síní je u pacientů se septickým šokem častá a zhoršuje hemodynamiku ztrátou síňové kontrakce, zkrácením diastolického plnění, poklesem srdečního výdeje a zvýšením plnících tlaků. V tomto kontextu je fibrilace síní spojena s delší dobou hospitalizace, vyšším rizikem ischemické cévní mozkové příhody a zvýšenou mortalitou. Patogeneze je multifaktoriální a kombinuje predispozice pacienta se spouštěči související s kritickým onemocněním, včetně nadměrného uvolnění katecholaminů, elektrolytové poruchy, dysregulace autonomního nervového systému, systémového zánětu, změn preloadu a afterloadu. Tyto faktory společně zvyšují arytmogenní potenciál a predisponují k rozvoji nově vzniklé fibrilace síní. Echokardiografie u lůžka pacienta umožnuje personalizovat diagnostiku, léčbu i prevenci. Parametry zaměřené na levou síň napomáhají odhadu rizika fibrilace síní, predikci udržení sinusového rytmu a zvolení vhodné strategie (kontrola rytmu vs. kontrola frekvence). Systematické, individualizované hodnocení levé síně spolu s posouzením diastolické a systolické funkce obou komor by mělo být nedílnou součástí péče o kriticky nemocné se septickým šokem. Přehled zároveň nabízí praktický algoritmus u lůžka pacienta pro stratifikaci a volbu terapie.

Keywords: nově vzniklá fibrilace síní, sepse, septický šok, echokardiografie, levá síň, antikoagulace.

Received: December 23, 2025; Revised: March 28, 2026; Accepted: March 28, 2026; Published: April 9, 2026  Show citation

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Tencer T, Waldauf P, Balik M. Levá síň a fibrilace síní u kriticky nemocných: od echokardiografie k terapii. Anest. intenziv. Med. 2026;37(1):28-35. doi: 10.36290/aim.2026.011.
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