Lévy S
University of Marseille, School of Medicine, Chief Cardiology Division, Hôpital Nord, France.
Pacing Clin Electrophysiol. 1997 Oct;20(10 Pt 2):2670-4. doi: 10.1111/j.1540-8159.1997.tb06115.x.
Atrial fibrillation (AF) is in most patients (approximately 70%) associated with organic heart disease including valvular heart disease, coronary artery disease, hypertension, hypertrophic cardiomyopathy, dilated cardiomyopathy, and congenital heart disease, mostly atrial septal defect in adults. In many chronic conditions, determining whether AF is the result or is unrelated to the underlying heart disease, remains unclear. The list of possible etiologies also include cardiac amyloidosis, hemochromatosis and endomyocardial fibrosis. Other heart diseases, such as mitral valve prolapse (without mitral regurgitation), calcifications of the mitral annulus, atrial myxoma, pheochomocytoma, and idiopathic dilated right atrium may present with AF. Atrial fibrillation may occur in the absence of detectable organic heart disease, the so-called "lone AF", in about 30% of cases. The term "idiopathic AF" implies the absence of any detectable etiology including hyperthyroidism, chronic obstructive lung disease, overt sinus node dysfunction, and overt or concealed preexcitation (Wolff-Parkinson-White syndrome), only to mention a few of other uncommon causes of AF. The autonomous nervous system may contribute to the occurrence of AF in some patients. AF occurs commonly. In patients with valvular heart disease, AF is common, particularly when the mitral valve is involved. The occurrence of AF is unrelated to the severity of mitral stenosis or mitral regurgitation but is more common in patients with enlarged left atrium and congestive heart failure. In patients with coronary artery disease, AF occurs predominantly in older patients, males, and patients with left ventricular dysfunction, Important predictive factors of AF include hypertension, left ventricular hypertrophy and diabetes. The risk of the development of AF, in an individual patient, is often difficult to assess. Increasing age, presence of valvular heart disease, and congestive heart failure increase the risk of atrial fibrillation.
在大多数患者中（约70%），心房颤动（AF）与器质性心脏病相关，包括瓣膜性心脏病、冠状动脉疾病、高血压、肥厚型心肌病、扩张型心肌病和先天性心脏病，在成年人中主要是房间隔缺损。在许多慢性疾病中，AF是潜在心脏病的结果还是与之无关仍不清楚。可能的病因还包括心脏淀粉样变性、血色素沉着症和心内膜纤维化。其他心脏病，如二尖瓣脱垂（无二尖瓣反流）、二尖瓣环钙化、心房黏液瘤、嗜铬细胞瘤和特发性右心房扩张也可能伴有AF。约30%的病例中，心房颤动可能在无明显器质性心脏病的情况下发生，即所谓的“孤立性AF”。“特发性AF”一词意味着不存在任何可检测到的病因，包括甲状腺功能亢进、慢性阻塞性肺疾病、明显的窦房结功能障碍以及显性或隐匿性预激（ Wolff-Parkinson-White综合征），这里仅列举一些AF的其他不常见病因。自主神经系统可能在一些患者中促使AF的发生。AF很常见。在瓣膜性心脏病患者中，AF很常见，尤其是当二尖瓣受累时。AF的发生与二尖瓣狭窄或二尖瓣反流的严重程度无关，但在左心房扩大和充血性心力衰竭患者中更常见。在冠状动脉疾病患者中，AF主要发生在老年患者、男性和左心室功能不全的患者中。AF的重要预测因素包括高血压、左心室肥厚和糖尿病。对于个体患者，AF发生的风险往往难以评估。年龄增长、瓣膜性心脏病的存在和充血性心力衰竭会增加心房颤动的风险。
