Warmus Paweł, Adamczyk-Sowa Monika
Katedra i Klinika Neurologii, Wydział Lekarski z Oddziałem Lekarsko- Dentystycznym w Zabrzu, Śląskiego Uniwersytetu, Medycznego w Katowicach, Zabrze, Polska.
Wiad Lek. 2018;71(9):1829-1834.
Atrial fibrillation is one of the most common causes of ischaemic stroke, especially among the elderly. Cardiogenic stroke accounts for approximately 15-25& of all ischaemic strokes, depending on different studies. About 1/3 of all ischaemic strokes have an unknown cause and it is estimated that paroxysmal atrial fibrillation contributes to cryptogenic ischaemic strokes. De novo atrial fibrillation accounts for even over 20& of ischaemic strokes. The number of patients with atrial fibrillation has probably increased due to the aging of the population and more precise diagnostic procedures. Detection of atrial fibrillation is of great importance because ischaemic stroke due to atrial fibrillation is characterized by a tendency to recurrence, worse prognosis, longer hospitalization and higher mortality. Atrial fibrillation remains undiagnosed in a large percentage of cases. Holter ECG monitoring is most often used for diagnostic purposes. However, the diagnostic process should also include long-term Holter ECG monitoring because atrial fibrillation is detected only in a small percentage of cases when 24-h ECG monitoring is used. Our paper stresses the fact that the diagnosis of atrial fibrillation, particularly de novo, is very important for further therapeutic treatment i.e. the use of anticoagulants i.e. both the antagonists of vitamin K and NOACs.
心房颤动是缺血性卒中最常见的病因之一，在老年人中尤为如此。心源性卒中约占所有缺血性卒中的15%-25%，具体比例取决于不同研究。约1/3的缺血性卒中病因不明，据估计阵发性心房颤动是隐匿性缺血性卒中的病因之一。新发心房颤动在缺血性卒中中所占比例甚至超过20%。由于人口老龄化和诊断程序更加精确，心房颤动患者的数量可能有所增加。心房颤动的检测非常重要，因为心房颤动所致缺血性卒中具有复发倾向、预后较差、住院时间较长和死亡率较高的特点。在很大比例的病例中，心房颤动仍未被诊断出来。动态心电图监测最常用于诊断目的。然而，诊断过程还应包括长期动态心电图监测，因为使用24小时心电图监测时，仅在一小部分病例中能检测到心房颤动。我们的论文强调了这样一个事实，即心房颤动的诊断，尤其是新发心房颤动的诊断，对于进一步的治疗，即使用抗凝剂，也就是维生素K拮抗剂和新型口服抗凝药，非常重要。
