From the Faculty of Medicine, Hebrew University and Hadassah Medical School, Jerusalem, Israel.
QJM. 2019 Apr 1;112(4):247-249. doi: 10.1093/qjmed/hcy130.
We review the prevalence, predictability, prognosis and preventability of atrial fibrillation and associated cardiogenic brain embolism, focusing on 'silent' sub-clinical atrial fibrillation (SCAF) which is very common in the elderly and associated with significantly increased risk of stroke and cardiovascular mortality. The current paradigm treats atrial fibrillation once discovered by its symptoms, complications (stroke) or by chance and screening recommendations are limited to opportunistic pulse palpation. We argue that the marked incidence of SCAF in patients over 65 justifies a much more active approach to identify patients at a particularly high-risk by routine evaluation of readily-available clinical, electrocardiographic, echocardiographic and laboratory markers. Elderly patients at high-risk need further monitoring by suitable devices (occasionally, long-term) and treatment with direct oral anti-coagulants once SCAF is revealed. This approach can already be adopted during clinical encounters at the general practitioner and consultant level, to decrease the substantial SCAF-associated morbidity and mortality.
我们回顾了心房颤动和相关心源性脑栓塞的患病率、可预测性、预后和可预防性，重点关注老年人中非常常见的“无症状”亚临床心房颤动（SCAF），其与中风和心血管死亡率显著增加相关。目前的治疗模式是一旦发现心房颤动的症状、并发症（中风）或偶然发现，就进行治疗，筛查建议仅限于机会性脉搏触诊。我们认为，65 岁以上患者中 SCAF 的发生率很高，这证明通过常规评估易于获得的临床、心电图、超声心动图和实验室标志物，以识别高危患者的方法更为有效。高风险的老年患者需要通过合适的设备（偶尔是长期的）进行进一步监测，一旦发现 SCAF，就需要使用直接口服抗凝剂进行治疗。这种方法已经可以在全科医生和顾问级别的临床就诊中采用，以降低与 SCAF 相关的大量发病率和死亡率。
