Stamboul Karim, Fauchier Laurent, Gudjoncik Aurelie, Buffet Philippe, Garnier Fabien, Lorgis Luc, Beer Jean Claude, Touzery Claude, Cottin Yves
Cardiology Department, University Hospital, Dijon, France; Laboratory of Cardiometabolic Physiopathology and Pharmacology, UMR INSERM U866, University of Burgundy, Dijon, France.
Cardiology Department, Trousseau University Hospital and François-Rabelais University, Tours, France.
Arch Cardiovasc Dis. 2015 Nov;108(11):598-605. doi: 10.1016/j.acvd.2015.06.009. Epub 2015 Oct 29.
Atrial fibrillation (AF) is the most frequent heart rhythm disorder in the general population and contributes not only to a major deterioration in quality of life but also to an increase in cardiovascular morbimortality. The onset of AF in the acute phase of myocardial infarction (MI) is a major event that can jeopardize the prognosis of patients in the short-, medium- and long-term, and is a powerful predictor of a poor prognosis after MI. The suspected mechanism underlying the excess mortality is the drop in coronary flow linked to the acceleration and arrhythmic nature of the left ventricular contractions, which reduce the left ventricular ejection fraction. The principal causes of AF-associated death after MI are linked to heart failure. Moreover, the excess risk of death in these heart failure patients has also been associated with the onset of sudden death. Whatever its form, AF has a major negative effect on patient prognosis. In recent studies, symptomatic AF was associated with inhospital mortality of 17.8%, to which can be added mortality at 1year of 18.8%. Surprisingly, silent AF also has a negative effect on the prognosis, as it is associated with an inhospital mortality rate of 10.4%, which remains high at 5.7% at 1year. Moreover, both forms of AF are independent predictors of mortality beyond traditional risk factors. The frequency and seriousness of silent AF in the short- and long-term, which were until recently rarely studied, raises the question of systematically screening for it in the acute phase of MI. Consequently, the use of continuous ECG monitoring could be a simple, effective and inexpensive solution to improve screening for AF, even though studies are still necessary to validate this strategy. Finally, complementary studies also effect of oxidative stress and endothelial dysfunction, which seem to play a major role in triggering this rhythm disorder.
心房颤动（AF）是普通人群中最常见的心律失常，不仅会导致生活质量严重下降，还会增加心血管疾病的发病率和死亡率。心肌梗死（MI）急性期发生AF是一个重大事件，会在短期、中期和长期危及患者预后，并且是MI后预后不良的有力预测指标。推测死亡率过高的潜在机制是与左心室收缩的加速和心律失常性质相关的冠状动脉血流下降，这会降低左心室射血分数。MI后与AF相关的死亡主要原因与心力衰竭有关。此外，这些心力衰竭患者额外的死亡风险也与猝死的发生有关。无论其形式如何，AF对患者预后都有重大负面影响。在最近的研究中，有症状的AF与17.8%的住院死亡率相关，此外1年死亡率为18.8%。令人惊讶的是，无症状AF对预后也有负面影响，因为它与10.4%的住院死亡率相关，1年时仍高达5.7%。此外，两种形式的AF都是传统危险因素之外死亡率的独立预测指标。无症状AF在短期和长期的发生频率和严重性，直到最近都很少被研究，这就提出了在MI急性期对其进行系统筛查的问题。因此，使用连续心电图监测可能是一种简单、有效且廉价的方法来改善AF的筛查，尽管仍需要研究来验证这一策略。最后，补充研究还关注氧化应激和内皮功能障碍的作用，它们似乎在引发这种心律失常中起主要作用。
