卒中和短暂性脑缺血发作后检出的心房颤动的新分类。
Towards a new classification of atrial fibrillation detected after a stroke or a transient ischaemic attack.
机构信息
Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Heart and Brain Laboratory, Western University, London, ON, Canada; Robarts Research Institute, Western University, London, ON, Canada; Lawson Health Research Institute, London, ON, Canada.
Division of Neurology, Vancouver Stroke Program, University of British Columbia, Vancouver, BC, Canada.
出版信息
Lancet Neurol. 2024 Jan;23(1):110-122. doi: 10.1016/S1474-4422(23)00326-5. Epub 2023 Oct 12.
Globally, up to 1·5 million individuals with ischaemic stroke or transient ischaemic attack can be newly diagnosed with atrial fibrillation per year. In the past decade, evidence has accumulated supporting the notion that atrial fibrillation first detected after a stroke or transient ischaemic attack differs from atrial fibrillation known before the occurrence of as stroke. Atrial fibrillation detected after stroke is associated with a lower prevalence of risk factors, cardiovascular comorbidities, and atrial cardiomyopathy than atrial fibrillation known before stroke occurrence. These differences might explain why it is associated with a lower risk of recurrence of ischaemic stroke than known atrial fibrillation. Patients with ischaemic stroke or transient ischaemic attack can be classified in three categories: no atrial fibrillation, known atrial fibrillation before stroke occurrence, and atrial fibrillation detected after stroke. This classification could harmonise future research in the field and help to understand the role of prolonged cardiac monitoring for secondary stroke prevention with application of a personalised risk-based approach to the selection of patients for anticoagulation.
全球每年有多达 150 万缺血性卒中和短暂性脑缺血发作患者可能新诊断为心房颤动。在过去的十年中，有证据支持这样一种观点，即在卒中和短暂性脑缺血发作后首次发现的心房颤动与发生卒中之前已知的心房颤动不同。与发生卒中之前已知的心房颤动相比，卒中后发现的心房颤动与较低的危险因素、心血管合并症和心房心肌病患病率相关。这些差异可能解释了为什么它与缺血性卒中复发的风险较低相关。缺血性卒中和短暂性脑缺血发作患者可分为三类：无心房颤动、卒中发生前已知的心房颤动和卒中后发现的心房颤动。这种分类可以协调该领域的未来研究，并有助于理解延长心脏监测在二级卒中预防中的作用，以及应用基于个体化风险的方法选择患者进行抗凝治疗。
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