Potpara Tatjana S, Lip Gregory Y H, Larsen Torben B, Madrid Antonio, Dobreanu Dan, Jędrzejczyk-Patej Ewa, Dagres Nikolaos
Cardiology Clinic, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Visegradska 26, 11000 Belgrade, Serbia
Cardiology Clinic, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Visegradska 26, 11000 Belgrade, Serbia.
Europace. 2016 Oct;18(10):1593-1598. doi: 10.1093/europace/euw302.
The purpose of this European Heart Rhythm Association (EHRA) Survey was to assess the perceptions of 'valvular' atrial fibrillation (AF) and management of AF patients with various heart valve abnormalities in daily clinical practice in European electrophysiology (EP) centres. Questionnaire survey was sent via the Internet to the EHRA-EP Research Network Centres. Of the 52 responding centres, 42 (80.8%) were university hospitals. Choosing the most comprehensive definition of valvular AF, a total of 49 centres (94.2%) encountered a mechanical prosthetic heart valve and significant rheumatic mitral stenosis, 35 centres (67.3%) also considered bioprosthetic valves, and 25 centres (48.1%) included any significant valvular heart disease, requiring surgical repair in the definition of valvular AF. Only three centres (5.8%) would define valvular AF as the presence of any (even mild) valvular abnormality. None of the centres would use non-vitamin K antagonist oral anticoagulants (NOACs) in AF patients with mechanical prosthetic valves, only 5 centres (9.8%) would use NOACs in patients with significant mitral stenosis, 17 centres (32.7%) would consider the use of NOACs in patients with bioprosthetic valves, and 21 centres (41.2%) would use NOACs in patients with a non-recent transcatheter valve replacement/implantation, while 13 centres (25.5%) would never consider the use of NOACs in AF patients with even mild native heart valve abnormality. Our survey showed marked heterogeneity in the definition of valvular AF and thromboprophylactic treatments, with the use of variable NOACs in patients with valvular heart disease other than prosthetic heart valves or significant mitral stenosis, indicating that this term may be misleading and should not be used.
欧洲心律协会(EHRA)这项调查的目的是评估在欧洲电生理(EP)中心的日常临床实践中,对于“瓣膜性”心房颤动(AF)的认知以及对患有各种心脏瓣膜异常的AF患者的管理情况。通过互联网向EHRA-EP研究网络中心发送了问卷调查。在52个回复中心中,42个(80.8%)是大学医院。采用瓣膜性AF最全面的定义,共有49个中心(94.2%)遇到机械人工心脏瓣膜和显著的风湿性二尖瓣狭窄,35个中心(67.3%)还考虑了生物瓣膜,25个中心(48.1%)在瓣膜性AF的定义中纳入了任何需要手术修复的显著瓣膜性心脏病。只有三个中心(5.8%)会将瓣膜性AF定义为存在任何(即使是轻度)瓣膜异常。没有中心会在有机械人工瓣膜的AF患者中使用非维生素K拮抗剂口服抗凝药(NOACs),只有5个中心(9.8%)会在有显著二尖瓣狭窄的患者中使用NOACs,17个中心(32.7%)会考虑在有生物瓣膜的患者中使用NOACs,21个中心(41.2%)会在近期未进行经导管瓣膜置换/植入的患者中使用NOACs,而13个中心(25.5%)即使对于有轻度原发性心脏瓣膜异常的AF患者也从不考虑使用NOACs。我们的调查显示,在瓣膜性AF的定义和血栓预防治疗方面存在显著异质性,在除人工心脏瓣膜或显著二尖瓣狭窄之外的瓣膜性心脏病患者中使用不同的NOACs,这表明该术语可能具有误导性,不应使用。
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