Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
Maroondah Hospital, Melbourne, Australia.
Clin Med (Lond). 2017 Oct;17(5):419-423. doi: 10.7861/clinmedicine.17-5-419.
Current guidelines support the well-established clinical practice that patients who present with atrial fibrillation (AF) of less than 48 hours duration should be considered for cardioversion, even in the absence of pre-existing anticoagulation. However, with increasing evidence that short runs of AF confer significant risk of stroke, on what evidence is this 48-hour rule based and is it time to adopt a new approach? We review existing evidence and suggest a novel approach to risk stratification in this setting. Overall, the risk of thromboembolism associated with acute cardioversion of patients with AF that is estimated to be of <48 hours duration is low. However, this risk varies widely depending on patient characteristics. From existing evidence, we show that using the CHADS-VASc score may allow better selection of appropriate patients in order to prevent exposing specific patient groups to an unacceptably high risk of a potentially devastating complication.
目前的指南支持这样一个已被广泛认可的临床实践，即对于持续时间少于 48 小时的心房颤动（AF）患者，即使没有预先存在的抗凝治疗，也应考虑进行心脏复律。然而，越来越多的证据表明，AF 的短暂发作会显著增加中风风险，那么这个 48 小时规则的依据是什么，是否是时候采取新的方法了？我们回顾了现有证据，并在这种情况下提出了一种新的风险分层方法。总的来说，持续时间<48 小时的 AF 患者进行急性心脏复律时，估计与血栓栓塞风险相关的风险较低。然而，这种风险因患者特征而异。从现有证据来看，我们发现使用 CHADS-VASc 评分可以更好地选择合适的患者，以避免将特定患者群体暴露于无法接受的潜在灾难性并发症的高风险之下。
