Division of Cardiology, Department of Medicine, University Hospital Basel, Switzerland / Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland / Population Health Research Institute, Hamilton, Ontario, Canada.
Swiss Med Wkly. 2020 Mar 22;150:w20196. doi: 10.4414/smw.2020.20196. eCollection 2020 Mar 9.
Atrial fibrillation (AF) has become a global epidemic and puts affected patients at high risk of adverse events. In this review we summarise the current evidence on risk factors and complications of AF, describe current treatment strategies, and outline new fields of research. Current evidence shows that hypertension and obesity are the two most important modifiable risk factors for the development of AF. Patients with AF face an increased stroke risk. Oral anticoagulation reduces this risk substantially. Mainly for reasons of safety and ease of use, non-vitamin K antagonist oral anticoagulants are preferred for stroke prevention. Rate and rhythm control interventions remain important and are mainly used for symptom control in AF patients. Rate control is recommended as an initial treatment and in patients with a low or absent symptom burden. Following the advent of AF ablation 20 years ago, the chances of successful sustained rhythm control have increased. Nevertheless, the procedural risks, although low, must be discussed with the patient in the context of the potential benefits. Heart failure and AF often coexist, which creates a further challenge for optimal AF management. Recent studies have shown that AF patients have a high burden of silent brain lesions, and that these lesions are associated with cognitive dysfunction. A better understanding of these interrelationships may eventually help the development of new prevention and treatment strategies to decrease the burden and complications associated with AF.
心房颤动（AF）已成为一种全球流行疾病，使受影响的患者面临高风险的不良事件。在这篇综述中，我们总结了 AF 的危险因素和并发症的现有证据，描述了当前的治疗策略，并概述了新的研究领域。现有证据表明，高血压和肥胖是 AF 发展的两个最重要的可改变危险因素。AF 患者面临更高的中风风险。口服抗凝剂可显著降低这种风险。主要由于安全性和使用便利性，新型口服抗凝剂（NOAC）更适用于预防中风。心率和节律控制干预仍然很重要，主要用于控制 AF 患者的症状。在有或没有低症状负担的情况下，推荐心率控制作为初始治疗。AF 消融 20 年前问世以来，成功实现持续节律控制的机会增加了。尽管如此，在潜在益处的背景下，必须与患者讨论程序风险，尽管风险很低。心力衰竭和 AF 经常同时存在，这给 AF 的最佳管理带来了进一步的挑战。最近的研究表明，AF 患者存在大量的无症状性脑损伤，这些损伤与认知功能障碍有关。更好地理解这些相互关系可能最终有助于制定新的预防和治疗策略，以降低与 AF 相关的负担和并发症。
