Crijns H J G M
Academisch Ziekenhuis, afd. Cardiologie, Maastricht.
Ned Tijdschr Geneeskd. 2004 Jul 17;148(29):1425-6.
Stroke is the most important complication of atrial fibrillation. The new practice guideline 'Atrial fibrillation' from the Dutch College of General Practitioners strongly advocates active detection of atrial fibrillation and antithrombotic treatment guided by stroke-risk stratification in order to decrease the risk of stroke. The stratification scheme it proposes skips age as a parameter. Instead, the general practitioners propose exclusive use of clinical risk factors such as previous stroke, hypertension, heart failure, coronary artery disease and diabetes. The practice guideline advocates abandoning rhythm control unless the patient is symptomatic and physically fit. The guideline also advocates referral to a cardiologist of a physically fit patient who is younger than the arbitrary age of 65 years. In summary, the new guideline is timely and appears after many new studies have provided important evidence for the optimal diagnosis and treatment of this frequent type of arrhythmia. This guideline will contribute significantly, not only to the improvement of daily clinical practice but also to scientific research. Both electrocardiography and echocardiography can be expected to play a larger role in the future in the patient with atrial fibrillation who is first seen by the general practitioner.
中风是心房颤动最重要的并发症。荷兰全科医生学院新发布的“心房颤动”实践指南强烈主张积极检测心房颤动，并根据中风风险分层进行抗血栓治疗，以降低中风风险。该指南提出的分层方案未将年龄作为参数。相反，全科医生建议仅使用临床风险因素，如既往中风、高血压、心力衰竭、冠状动脉疾病和糖尿病。该实践指南主张，除非患者有症状且身体状况良好，否则应放弃节律控制。该指南还主张，对于身体状况良好但年龄小于65岁这一任意设定年龄的患者，应转诊至心脏病专家处。总之，新指南发布及时，是在许多新研究为这种常见心律失常的最佳诊断和治疗提供了重要证据之后出台的。该指南不仅将对日常临床实践的改善，而且对科学研究都有重大贡献。预计心电图和超声心动图未来在首次由全科医生接诊的心房颤动患者中将发挥更大作用。
