Levy Samuel
University of Marseille, School of Medicine, Chief Cardiology Division, Hôpital Nord, Marseille, France.
Anadolu Kardiyol Derg. 2002 Mar;2(1):55-60.
Atrial fibrillation (AF) is a common clinical problem, particularly in the elderly, and in patients with organic heart disease. A small percentage of patients, have a potentially reversible cause. Atrial fibrillation is in most patients (approximately 70%) associated with chronic organic heart disease including valvular heart disease, coronary artery disease, hypertension, particularly if left ventricular hypertrophy is present, hypertrophic cardiomyopathy, dilated cardiomyopathy and congenital heart disease and most commonly in adults, atrial septal defect. As in many chronic conditions, determining whether AF is the result or is unrelated to the underlying heart disease, remains unclear. The list of possible etiologies also include cardiac amyloidosis, hemochromatosis and endomyocardial fibrosis. Other heart diseases, such as mitral valve prolapse (with or without mitral regurgitation), calcification of the mitral annulus, atrial myxoma, pheochomocytoma and idiopathic dilated right atrium, present a higher incidence of AF. The relationship between these findings and the arrhythmia are still unclear. Atrial fibrillation may occur in the absence of detectable organic heart disease, the so-called "lone AF", in about 30% of cases. The term "lone AF" or "idiopathic AF" implies the absence of any detectable etiology including hyperthyroidism, chronic obstructive lung disease, overt sinus node dysfunction, and overt or concealed preexcitation (Wolf-Parkinson-White syndrome), only to mention a few of other rare causes of AF. In every instance of recently discovered AF, thyrotoxicosis should be ruled out. The autonomous nervous system may contribute to the occurrence of AF in some patients. Atrial fibrillation occurs commonly in patients with valvular heart disease, particularly when it involves the mitral valve. The occurrence of AF is unrelated to the severity of mitral stenosis but is more common in patients with enlarged left atrium and congestive heart failure. In patients with coronary artery disease, Af occurs predominantly in older patients, males and patients with left ventricular dysfunction. Important predictive factors of AF include hypertension, left ventricular hypertrophy and diabetes. However, the relation between AF and hypertension remains unclear. The risk of the development of AF, in an individual patient, is often difficult to assess but increasing age, presence of valvular heart disease and congestive heart failure, increase the risk of AF.
心房颤动（AF）是一个常见的临床问题，在老年人以及患有器质性心脏病的患者中尤为常见。一小部分患者存在潜在可逆的病因。在大多数患者（约70%）中，心房颤动与慢性器质性心脏病相关，包括瓣膜性心脏病、冠状动脉疾病、高血压（尤其是存在左心室肥厚时）、肥厚型心肌病、扩张型心肌病和先天性心脏病，在成年人中最常见的是房间隔缺损。与许多慢性疾病一样，尚不清楚心房颤动是潜在心脏病的结果还是与之无关。可能的病因还包括心脏淀粉样变性、血色素沉着症和心内膜纤维化。其他心脏病，如二尖瓣脱垂（伴或不伴二尖瓣反流）、二尖瓣环钙化、心房黏液瘤、嗜铬细胞瘤和特发性右心房扩张，心房颤动的发生率较高。这些发现与心律失常之间的关系仍不清楚。在约30%的病例中，心房颤动可能在无明显器质性心脏病的情况下发生，即所谓的“孤立性房颤”。“孤立性房颤”或“特发性房颤”这一术语意味着不存在任何可检测到的病因，包括甲状腺功能亢进、慢性阻塞性肺疾病、明显的窦房结功能障碍以及明显或隐匿的预激（ Wolff-Parkinson-White综合征），这里仅列举少数其他罕见的房颤病因。在每例新发现的房颤病例中，都应排除甲状腺毒症。自主神经系统可能在某些患者房颤的发生中起作用。心房颤动常见于瓣膜性心脏病患者，尤其是累及二尖瓣时。房颤的发生与二尖瓣狭窄的严重程度无关，但在左心房扩大和充血性心力衰竭的患者中更常见。在冠状动脉疾病患者中，房颤主要发生在老年患者、男性和左心室功能不全的患者中。房颤的重要预测因素包括高血压、左心室肥厚和糖尿病。然而，房颤与高血压之间的关系仍不清楚。个体患者发生房颤的风险往往难以评估，但年龄增长、瓣膜性心脏病和充血性心力衰竭的存在会增加房颤的风险。
