Sgarra Luca, Desantis Vanessa, Matteucci Andrea, Caccavo Vincenzo Paolo, Troisi Federica, Di Monaco Antonio, Mangini Francesco, Katsouras Grigorios, Guaricci Andrea Igoren, Dadamo Michele Luca, Fortunato Fabrizio, Nacci Carmela, Potenza Maria Assunta, Montagnani Monica, Grimaldi Massimo
Cardiology Unit, Medicine Department, General Hospital "F. Miulli" Acquaviva delle Fonti, 70021 Bari, Italy.
Pharmacology Section, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro Medical School, 70124 Bari, Italy.
Biomedicines. 2025 Mar 7;13(3):660. doi: 10.3390/biomedicines13030660.
At its earliest appearance, atrial fibrillation (AF) is often unnoticed, asymptomatic, and/or merely device-detected. Widespread use of heart-rate monitoring technologies has facilitated such "nascent atrial fibrillation (nAF)" recognition. Consequently, clinicians face a growing number of patients affected by new-onset AF in the absence of a definite indication for anticoagulation due to several counterarguments: (1) a CHADS-VA score ≤ 1 in otherwise apparently healthy subjects; (2) an uncertain embolic/hemorrhagic benefit/risk ratio with anticoagulation; (3) EKG demonstration and confirmation of AF; and (4) existence of a pathogenic mechanism other than atrial hypercoagulability. In this frustrating limitation of pharmacological options, cardiologists may miss a complete comprehension of drugs with proven anti-ictal potential, whose administration may serve both as a bridge strategy toward future anticoagulation and as a consolidative strategy paralleling anticoagulation. This review aims to summarize and elucidate such therapeutic strategies and their preventative mechanisms.
房颤（AF）最早出现时，往往未被注意到、无症状，和/或只是通过设备检测到。心率监测技术的广泛应用促进了这种“初发性房颤（nAF）”的识别。因此，由于以下几个反对理由，临床医生面临着越来越多新发房颤患者，而这些患者却没有明确的抗凝指征：（1）在其他方面看似健康的受试者中，CHADS-VA评分≤1；（2）抗凝的栓塞/出血获益/风险比不确定；（3）心电图显示并确诊房颤；（4）存在除心房高凝性以外的致病机制。在这种令人沮丧的药物选择限制下，心脏病专家可能会忽略对具有已证实抗发作潜力药物的全面理解，这些药物的使用既可以作为通向未来抗凝治疗的桥梁策略，也可以作为与抗凝治疗并行的巩固策略。本综述旨在总结并阐明此类治疗策略及其预防机制。
