Seidl K, Hauer B, Schwick N G, Zellner D, Zahn R, Senges J
Herzzentrum Ludwigshafen, Cardiology, Germany.
Am J Cardiol. 1998 Sep 1;82(5):580-3. doi: 10.1016/s0002-9149(98)00419-6.
Based on multiple studies, clear, guided anticoagulation therapy is recommended for patients with atrial fibrillation. The value of anticoagulation therapy in patients with atrial flutter, however, is less well established. Little is known about the incidence of thromboembolism in patients with atrial flutter. We evaluated the risk of thromboembolism in 191 consecutive unselected patients referred for treatment of atrial flutter. A history of embolic events was noted in 11 patients. Acute embolism (<48 hours) occurred in 4 patients (3 after direct current cardioversion, 1 after catheter ablation). During follow-up of 26+/-18 months, 9 patients experienced thromboembolic events. During the follow-up, the overall embolic event rate (including acute embolism and thromboembolic events during follow-up) was 7 % in this patient population. Risk indicators for an embolic event in an univariate analysis were organic heart disease (p = 0.037), depressed left ventricular function (p = 0.02), history of systemic hypertension (p = 0.004), and diabetes mellitus (p = 0.0038). Using multivariate analysis, a history of hypertension was the only independent predictor for elevated embolic risk in this patient population (odds ratio = 6.5; 95% confidence intervals 1.5 to 45). Thus, the thromboembolic risk is higher than previously recognized for patients with atrial flutter. Anticoagulation therapy may decrease this risk.
基于多项研究，推荐对房颤患者进行明确的、有指导的抗凝治疗。然而，抗凝治疗在房扑患者中的价值尚不明确。关于房扑患者血栓栓塞的发生率知之甚少。我们评估了191例连续入选的因房扑接受治疗的未选择患者的血栓栓塞风险。11例患者有栓塞事件史。4例患者发生急性栓塞（<48小时）（3例在直流电复律后，1例在导管消融后）。在26±18个月的随访期间，9例患者发生血栓栓塞事件。在随访期间，该患者群体的总体栓塞事件发生率（包括急性栓塞和随访期间的血栓栓塞事件）为7%。单因素分析中，栓塞事件的风险指标为器质性心脏病（p = 0.037）、左心室功能不全（p = 0.02）、系统性高血压病史（p = 0.004）和糖尿病（p = 0.0038）。多因素分析显示，高血压病史是该患者群体栓塞风险升高的唯一独立预测因素（优势比 = 6.5；95%置信区间1.5至45）。因此，房扑患者的血栓栓塞风险高于先前的认识。抗凝治疗可能会降低这种风险。
