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应对当前房颤挑战的实用综合方法:专家小组见解

Practical Comprehensive Approach to Current Atrial Fibrillation Challenges: Insights from an Expert Panel.

作者信息

Escobar Carlos, Camafort Miguel, Fortuny Elena, Grymonprez Maxim, Pérez-Cabeza Alejandro Isidoro, de Backer Tine L

机构信息

Cardiology Service, University Hospital La Paz, 28046 Madrid, Spain.

Internal Medicine Service, Atrial Fibrillation Unit, Hospital Clínic Barcelona, 08036 Barcelona, Spain.

出版信息

J Clin Med. 2025 Jul 22;14(15):5199. doi: 10.3390/jcm14155199.


DOI:10.3390/jcm14155199
PMID:40806821
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12346891/
Abstract

: Atrial fibrillation (AF) is a very common arrhythmia and the main cause of embolic events. Early diagnosis and treatment are crucial to prevent thromboembolic events. Although DOACs are an important advance in AF management, optimization is required. This study aims to evaluate the newly available evidence and experts' opinions on the clinical care of AF patients and to develop a set of practical recommendations to improve the management of patients with AF. : A questionnaire was developed on the topics of AF diagnosis, stroke prevention, rate and rhythm control, and management of comorbidities, based on the scientific committee's judgment and a rapid literature review. The level of agreement of the panelists with each statement was evaluated using the Likert 5-point scale. The results of the questionnaire were discussed in a final meeting and practical recommendations were made. : Thirty-five Spanish panelists, all experts in AF management, answered the questionnaire. Most of the statements (78%) reached the levels of agreement or unanimity. Discrepancy (9%) and rejection (13%) were also reported. : This study underscores the importance of a 12-lead electrocardiogram to diagnose AF, with wearable devices serving as useful tools; catheter ablation as a superior strategy for restoring and maintaining sinus rhythm compared to pharmacotherapy; the importance of comorbidity management to reduce incidence and recurrence of AF; adherence and persistence as critical factors for the efficacy and safety of anticoagulation; and the preference for DOACs, particularly apixaban and edoxaban, for stroke prevention in patients ≥75 years old or with chronic kidney disease.

摘要

心房颤动(AF)是一种非常常见的心律失常,也是栓塞事件的主要原因。早期诊断和治疗对于预防血栓栓塞事件至关重要。尽管直接口服抗凝剂(DOACs)是房颤管理方面的一项重要进展,但仍需要优化。本研究旨在评估关于房颤患者临床护理的最新证据和专家意见,并制定一套实用建议以改善房颤患者的管理。 基于科学委员会的判断和快速文献综述,制定了一份关于房颤诊断、卒中预防、心率和节律控制以及合并症管理的问卷。使用李克特5级量表评估小组成员对每项陈述的同意程度。在一次最终会议上讨论了问卷结果并提出了实用建议。 35名西班牙小组成员,均为房颤管理方面的专家,回答了问卷。大多数陈述(78%)达到了同意或一致同意的水平。也有不同意见(9%)和反对意见(13%)的报告。 本研究强调了12导联心电图对诊断房颤的重要性,可穿戴设备是有用的工具;与药物治疗相比,导管消融是恢复和维持窦性心律的更优策略;合并症管理对于降低房颤发病率和复发率的重要性;依从性和持续性是抗凝疗效和安全性的关键因素;以及对于≥75岁或患有慢性肾病的患者,在预防卒中方面对DOACs的偏好,尤其是阿哌沙班和依度沙班。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d671/12346891/e63d1b094777/jcm-14-05199-g001a.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d671/12346891/e63d1b094777/jcm-14-05199-g001a.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d671/12346891/e63d1b094777/jcm-14-05199-g001a.jpg

相似文献

[1]
Practical Comprehensive Approach to Current Atrial Fibrillation Challenges: Insights from an Expert Panel.

J Clin Med. 2025-7-22

[2]
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[3]
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[4]
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[5]
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[6]
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[7]
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Cochrane Database Syst Rev. 2017-11-6

[8]
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[9]
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Cochrane Database Syst Rev. 2013-8-8

[10]
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本文引用的文献

[1]
Adherence and persistence with direct oral anticoagulants by dose regimen: A systematic review.

Br J Clin Pharmacol. 2025-4

[2]
Results of ICE-Guided Isolation of the Superior Vena Cava With Pulsed Field Ablation.

JACC Clin Electrophysiol. 2025-4

[3]
Achieving Real-Time Prediction of Paroxysmal Atrial Fibrillation Onset by Convolutional Neural Network and Sliding Window on R-R Interval Sequences.

Bioengineering (Basel). 2024-9-10

[4]
Management of atrial fibrillation in older adults.

BMJ. 2024-9-17

[5]
2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS).

Eur Heart J. 2024-9-29

[6]
2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.

Circulation. 2024-1-2

[7]
Apixaban for Stroke Prevention in Subclinical Atrial Fibrillation.

N Engl J Med. 2024-1-11

[8]
Minimal Adherence Threshold to Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation to Reduce the Risk of Thromboembolism and Death: A Nationwide Cohort Study.

Cardiovasc Drugs Ther. 2025-2

[9]
Pulsed Field or Conventional Thermal Ablation for Paroxysmal Atrial Fibrillation.

N Engl J Med. 2023-11-2

[10]
Safety of Switching From a Vitamin K Antagonist to a Non-Vitamin K Antagonist Oral Anticoagulant in Frail Older Patients With Atrial Fibrillation: Results of the FRAIL-AF Randomized Controlled Trial.

Circulation. 2024-1-23

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