Iuliano Luigi, Di Matteo Antonio, Straface Giuseppe
Department of Internal Medicine, Unit of Vascular Medicine, Sapienza University of Rome, Rome, Italy.
Indian J Med Sci. 2009 Sep;63(9):419-30.
Atrial fibrillation is the most common arrhythmia in clinical practice, may coexist with conditions common to both cardiovascular and noncardiovascular diseases and is associated with considerable morbidity and mortality. Atrial fibrillation is often asymptomatic and diagnosed only when it has caused a potentially serious complication, such as an ischemic stroke. When atrial fibrillation has been identified, 2 objectives have to be addressed--the antiarrhythmic therapy based on rate control or rhythm control, and prevention of thromboembolism. A rhythm or rate control strategy can be chosen indifferently because they have comparable efficacy for the outcome measure of mortality, but the antithrombotic therapy is ever mandatory. The risk of stroke increases cumulatively with increasing age, previous transient ischemic attack or stroke, hypertension, diabetes mellitus, impaired left ventricular function and heart failure. Warfarin reduces the risk of stroke by about two thirds; and aspirin, by about one fifth, but its use must be weighted with the risk of bleeding. The risk of anticoagulant-associated hemorrhage increases with age, the presence of serious concomitant diseases, with poorly controlled hypertension and poorly controlled anticoagulation.
心房颤动是临床实践中最常见的心律失常，可能与心血管疾病和非心血管疾病共有的情况并存，并且与相当高的发病率和死亡率相关。心房颤动通常无症状，仅在引起潜在严重并发症（如缺血性中风）时才被诊断出来。当识别出心房颤动时，必须解决两个目标——基于心率控制或节律控制的抗心律失常治疗以及预防血栓栓塞。可以无差别地选择节律或心率控制策略，因为它们对死亡率的结局指标具有相当的疗效，但抗血栓治疗始终是必需的。中风风险随着年龄增长、既往短暂性脑缺血发作或中风、高血压、糖尿病、左心室功能受损和心力衰竭而累积增加。华法林可将中风风险降低约三分之二；阿司匹林可降低约五分之一，但使用时必须权衡出血风险。抗凝相关出血风险随着年龄增长、严重合并症的存在、高血压控制不佳和抗凝控制不佳而增加。
