The Departments of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, and Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
J Cardiovasc Electrophysiol. 2023 Oct;34(10):2163-2178. doi: 10.1111/jce.15803. Epub 2023 Jan 14.
Atrial fibrillation (AF) is one of the most common arrhythmias in adults, and its continued rise in the United States is complicated by the increased incidence and prevalence of several AF risk factors, such as obesity, physical inactivity, hypertension, obstructive sleep apnea, diabetes mellitus, coronary artery disease, and alcohol, tobacco, or caffeine use. Lifestyle and risk factor modification has been proposed as an additional pillar of AF therapy, added to rhythm control, rate control, and anticoagulation, to reduce AF burden and risk. Although emerging evidence largely supports the integration of lifestyle and risk factor management in clinical practice, randomized clinical trials investigating the long-term sustainability and reproducibility of these benefits remain sparse. The purpose of this review is to discuss potentially reversible risk factors on AF, share evidence for the impact on AF by modification of these risk factors, and then provide an overview of the effects of reversing or managing these risk factors on the success of various AF management strategies, such as antithrombotic, rate control, and rhythm control therapies.
心房颤动(AF)是成年人中最常见的心律失常之一,在美国,其发病率和患病率不断上升,这与几种 AF 风险因素的发生率增加有关,如肥胖、身体活动不足、高血压、阻塞性睡眠呼吸暂停、糖尿病、冠状动脉疾病以及酒精、烟草或咖啡因的使用。生活方式和风险因素的改变已被提议作为 AF 治疗的另一个支柱,与节律控制、心率控制和抗凝治疗一起,以减轻 AF 负担和风险。尽管新出现的证据在很大程度上支持将生活方式和风险因素管理纳入临床实践,但仍缺乏调查这些益处的长期可持续性和可重复性的随机临床试验。本综述的目的是讨论 AF 相关的潜在可逆转风险因素,分享这些风险因素改变对 AF 的影响,并概述逆转或管理这些风险因素对各种 AF 管理策略(如抗血栓、心率控制和节律控制治疗)成功的影响。