McIntyre William F, Connolly Stuart J, Healey Jeff S
Population Health Research Institute and McMaster University, Hamilton, Ontario, Canada.
Curr Opin Cardiol. 2018 Jan;33(1):58-65. doi: 10.1097/HCO.0000000000000475.
Atrial fibrillation may be detected in the setting of an acute stressor, such as medical illness or surgery. It is uncertain if atrial fibrillation detected in these settings (AFOTS: atrial fibrillation occurring transiently with stress) is secondary to a reversible trigger or is simply paroxysmal atrial fibrillation. This distinction is critical for clinicians, who must decide if AFOTS can be dismissed as a reversible phenomenon, or if it signals the need for chronic therapy; in particular, anticoagulation.
Published studies report incidences of AFOTS ranging from 1 to 44% in patients with acute medical illness and 1 to 35% following noncardiac surgery. The highest estimates have been reported in critically ill patients and in those undergoing continuous monitoring. A small number of studies have reported the recurrence of atrial fibrillation after AFOTS to be 55-68% within 5 years of medical illness and 37% within 1 year after noncardiac surgery. These studies are limited by retrospective design and low-sensitivity ascertainment.
AFOTS commonly occurs in patients with acute medical illness or in the postoperative state, and atrial fibrillation recurs in over 50% of individuals. Prospective postdischarge studies using sensitive atrial fibrillation detection strategies are needed to define the relationship between AFOTS and clinical atrial fibrillation.
心房颤动可能在急性应激源的情况下被检测到，如内科疾病或手术。在这些情况下检测到的心房颤动（AFOTS：应激时短暂发生的心房颤动）是继发于可逆性触发因素还是仅仅是阵发性心房颤动尚不确定。这种区分对临床医生至关重要，他们必须决定AFOTS是否可被视为可逆现象而不予理会，或者它是否表明需要进行长期治疗；特别是抗凝治疗。
已发表的研究报告，急性内科疾病患者中AFOTS的发生率为1%至44%，非心脏手术后为1%至35%。在重症患者和接受持续监测的患者中报告的估计发生率最高。少数研究报告，内科疾病后5年内AFOTS后心房颤动的复发率为55%至68%，非心脏手术后1年内为37%。这些研究受到回顾性设计和低敏感性确定的限制。
AFOTS常见于急性内科疾病患者或术后状态，超过50%的个体心房颤动会复发。需要采用敏感的心房颤动检测策略进行出院后前瞻性研究，以确定AFOTS与临床心房颤动之间的关系。
