Krishnamoorthy Suresh, Lip Gregory Y H, Lane Deirdre A
University Department of Medicine, City Hospital, Birmingham, England, UK.
Am J Med. 2009 Sep;122(9):851-856.e3. doi: 10.1016/j.amjmed.2009.02.012.
Atrial fibrillation in young patients (<or=45 years) is uncommon. There is the perception that the precipitant in such cases is alcohol, but we also have noted cases related to illicit drug abuse. There are no clear guidelines on the treatment of atrial fibrillation in patients presenting with "lone atrial fibrillation" precipitated by alcohol or illicit drugs.
We retrospectively analyzed young (defined as <or=45 years) patients with "lone" atrial fibrillation who were admitted to the hospital with electrocardiographically confirmed diagnosis of atrial fibrillation or atrial flutter, precipitated by either alcohol or illicit drugs, over a 6-year period.
Eighty-eight patients aged <or=45 years were admitted with atrial fibrillation or atrial flutter. In 22 patients, (mean [SD] age 33.6 [8.4] years; 20 male), alcohol (n = 19) and/or illicit drugs (n = 3) were found to be the precipitant. One patient required electrical cardioversion, with the remaining patients cardioverting back to sinus rhythm either pharmacologically or spontaneously. Twelve (54.5%) were investigated for atrial fibrillation burden by 24-hour Holter monitoring and the majority also underwent a transthoracic echocardiogram (81.8%). At discharge, 14 (63.6%) patients were treated with anti-arrhythmic drugs and 10 received either antiplatelets or anticoagulants. Most (85%) patients were followed-up for at least 12 months, during which time 6 had further paroxysms; all of whom continued to abuse either alcohol or illicit drugs.
Alcohol and illicit drugs are arrhythmogenic and are associated with atrial fibrillation. Apart from abstinence, the optimal management of such patients and the long-term effects of these substances on the heart and atrial fibrillation recurrences are still unclear.
年轻患者（≤45岁）发生心房颤动并不常见。人们认为此类病例的诱发因素是酒精，但我们也注意到一些与非法药物滥用相关的病例。对于由酒精或非法药物引发“孤立性心房颤动”的患者，目前尚无关于心房颤动治疗的明确指南。
我们回顾性分析了6年间因酒精或非法药物诱发、心电图确诊为心房颤动或心房扑动而入院的年轻（定义为≤45岁）“孤立性”心房颤动患者。
88例≤45岁的患者因心房颤动或心房扑动入院。在22例患者中（平均[标准差]年龄33.6[8.4]岁；20例男性），发现酒精（n = 19）和/或非法药物（n = 3）为诱发因素。1例患者需要电复律，其余患者通过药物治疗或自行恢复窦性心律。12例（54.5%）患者通过24小时动态心电图监测评估心房颤动负荷，大多数患者还接受了经胸超声心动图检查（81.8%）。出院时，14例（63.6%）患者接受抗心律失常药物治疗，10例接受抗血小板或抗凝药物治疗。大多数（85%）患者接受了至少12个月的随访，在此期间6例患者再次发作；所有这些患者均继续滥用酒精或非法药物。
酒精和非法药物具有致心律失常作用，并与心房颤动相关。除了戒酒戒毒外，此类患者的最佳管理方式以及这些物质对心脏和心房颤动复发的长期影响仍不明确。
