Kalman J M, Tonkin A M
Austin Hospital, Heidelberg, Victoria, Australia.
Pacing Clin Electrophysiol. 1992 Sep;15(9):1332-46. doi: 10.1111/j.1540-8159.1992.tb03143.x.
Atrial fibrillation is a common disorder and the incidence increases with each decade of life. Previously, rheumatic mitral valve disease has been the condition most highly associated with atrial fibrillation. However, with the decreasing incidence of rheumatic heart disease, other conditions have assumed greater importance and now congestive cardiac failure, coronary artery disease, and hypertension are the most commonly associated conditions. Nonrheumatic atrial fibrillation is associated with an approximately five-fold increase in the risk of ischemic stroke and a 5% to 7% yearly risk that increases with age. In addition, atrial fibrillation is associated with an increased incidence of silent cerebral infarction and increased mortality. However, whether atrial fibrillation is independently associated with the risk of stroke or is a marker of underlying cardiac disease is contentious. Until recently, the use of preventive therapy has been controversial. However, data from four recently published, prospective randomized studies clearly support the use of warfarin prophylaxis in nonrheumatic atrial fibrillation. Within the diverse group of patients with nonrheumatic atrial fibrillation there are high and low risk subgroups and identification of these may influence decisions regarding antithrombotic prophylaxis. With a few exceptions, however, this remains an area in which there are contradictory findings in the literature. The role of aspirin for prophylaxis in nonrheumatic atrial fibrillation remains unclear and further evaluation awaits the publication of ongoing studies.
心房颤动是一种常见疾病，其发病率随年龄每增长十岁而增加。此前，风湿性二尖瓣疾病一直是与心房颤动关联度最高的病症。然而，随着风湿性心脏病发病率的下降，其他病症变得愈发重要，目前充血性心力衰竭、冠状动脉疾病和高血压是最常与之相关的病症。非风湿性心房颤动使缺血性中风风险增加约五倍，且每年有5%至7%的风险，该风险随年龄增长而上升。此外，心房颤动与无症状性脑梗死发病率增加及死亡率上升相关。然而，心房颤动是独立与中风风险相关，还是潜在心脏病的一个标志，这存在争议。直到最近，预防性治疗的使用一直存在争议。然而，最近发表的四项前瞻性随机研究的数据明确支持在非风湿性心房颤动中使用华法林进行预防。在非风湿性心房颤动患者这一多样群体中，存在高风险和低风险亚组，识别这些亚组可能会影响抗血栓预防的决策。然而，除了少数例外情况，这仍然是一个文献中有相互矛盾发现的领域。阿司匹林在非风湿性心房颤动预防中的作用仍不明确，进一步评估有待正在进行的研究结果公布。
