Guichard Jean-Baptiste, Guasch Eduard, Roche Frederic, Da Costa Antoine, Mont Lluís
Arrhythmia Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
Front Physiol. 2022 Oct 24;13:971691. doi: 10.3389/fphys.2022.971691. eCollection 2022.
An increased burden of premature atrial contractions (PACs) has long been considered a benign phenomenon. However, strong evidence of their involvement in the occurrence of atrial fibrillation (AF), ischemic stroke, and excess mortality suggests the need for management. The central question to be resolved is whether increased ectopic atrial rhythm is only a predictor of AF or whether it is a marker of atrial cardiomyopathy and therefore of ischemic stroke. After reviewing the pathophysiology of PACs and its impact on patient prognosis, this mini-review proposes to 1) detail the physiological and clinical elements linking PACs and AF, 2) present the evidence in favor of supraventricular ectopic activity as a marker of cardiomyopathy, and 3) outline the current limitations of this concept and the potential future clinical implications.
长期以来，过早房性收缩（PACs）负担增加一直被视为一种良性现象。然而，有强有力的证据表明它们与房颤（AF）的发生、缺血性中风及过高死亡率有关，这表明需要进行管理。有待解决的核心问题是，异位房性心律增加仅仅是房颤的一个预测指标，还是心房心肌病的一个标志，进而也是缺血性中风的标志。在回顾了PACs的病理生理学及其对患者预后的影响后，本综述提出：1）详细阐述将PACs与房颤联系起来的生理和临床因素；2）列举支持室上性异位活动作为心肌病标志的证据；3）概述这一概念目前的局限性以及未来潜在的临床意义。
