Scardi S, Mazzone C
Ital Heart J Suppl. 2000 Sep;1(9):1117-22.
The largest cohort studies and a number of other epidemiological or clinical studies have found an increased risk of total, cardiovascular and stroke mortality in patients (both men and women of every age) with chronic non-rheumatic atrial fibrillation (AF) compared to heterogeneous individuals in normal sinus rhythm. These studies suggested that AF increases the probability of death without changing the mode of death. Many excess deaths due to non-rheumatic AF occur soon after the diagnosis of the arrhythmia. Non-rheumatic AF is complicated by the heterogeneity of the underlying heart disease and accompanying medications. Prognosis in non-rheumatic AF is dependent upon the age of the patients and the underlying cardiac conditions but non-rheumatic AF is a potent risk factor for stroke. Stroke in patients with non-rheumatic AF is generally more severe and induces higher mortality. A recent Framingham study has shown that an increased mortality rate persists when adjusted for age, hypertension, smoking, myocardial infarction, congestive heart failure, and stroke or transient ischemic attacks. These results demonstrate that non-rheumatic AF is independently associated with a 50 to 90% increase in the risk of death. Also the excess mortality observed in patients with chronic lone AF supports the independent role of the arrhythmia. The higher incidence of a chronic arrhythmia and the known complications of this condition pose serious problems for health care as our population ages. Passive acceptance of non-rheumatic AF is not correct. In all patients with non-rheumatic AF, restoring and maintaining sinus rhythm for as long as possible needs to be taken into serious consideration. New antiarrhythmic drugs and new strategies for the management of non-rheumatic AF are accumulating. When the arrhythmia is chronic, correct anticoagulant prophylaxis is a must, as several randomized trials have demonstrated a significant reduction in thromboembolic stroke incidence and related mortality with an acceptable hemorrhagic risk by using warfarin.
最大规模的队列研究以及其他一些流行病学或临床研究发现，与处于正常窦性心律的异质性个体相比，患有慢性非风湿性心房颤动（AF）的患者（各年龄段的男性和女性）全因死亡率、心血管死亡率和中风死亡率均有所增加。这些研究表明，AF增加了死亡概率，但并未改变死亡方式。许多非风湿性AF导致的额外死亡在心律失常诊断后不久就会发生。非风湿性AF因潜在心脏病和伴随用药的异质性而变得复杂。非风湿性AF的预后取决于患者年龄和潜在心脏状况，但非风湿性AF是中风的一个重要危险因素。非风湿性AF患者的中风通常更严重，死亡率更高。最近的一项弗雷明汉研究表明，在对年龄、高血压、吸烟、心肌梗死、充血性心力衰竭以及中风或短暂性脑缺血发作进行校正后，死亡率仍然升高。这些结果表明，非风湿性AF与死亡风险增加50%至90%独立相关。此外，在慢性孤立性AF患者中观察到的额外死亡率也支持了这种心律失常的独立作用。随着我们的人口老龄化，慢性心律失常的较高发病率及其已知并发症给医疗保健带来了严重问题。被动接受非风湿性AF是不正确的。对于所有非风湿性AF患者，都需要认真考虑尽可能长时间地恢复并维持窦性心律。治疗非风湿性AF的新型抗心律失常药物和新策略正在不断积累。当心律失常为慢性时，正确的抗凝预防是必需的，因为多项随机试验表明，使用华法林可使血栓栓塞性中风发病率和相关死亡率显著降低，且出血风险可接受。
