心房颤动患者植入植入式心脏复律除颤器术后肾梗死1例及文献复习

1例合并阵发性心房颤动（AF）的老年女性因室性心动过速（VT）而植入植入式心脏复律除颤器（ICD），围术期为避免出血风险，未予抗凝治疗，术后7d出现发热、腹痛，完善检查后诊断为肾梗死，立即开始规律抗凝治疗。目前针对AF患者植入心脏节律装置（CRD）围术期不同抗凝策略的安全性及有效性仍有争议。AF患者合并肾梗死相对少见，且该患者临床表现不典型，增加了早期诊断的难度。该病例带给我们的启示是：（1）对于卒中高危的AF患者，在植入CRD的围术期，抗凝治疗是必要的，但是采用何种抗凝策略尚有争议；（2）对于卒中高危的AF患者，在无抗凝的情况下，出现急腹症等表现时，应考虑腹腔脏器急性栓塞梗死的可能性。

Renal infarction due to atrial fibrillation after implantation of implantable cardioverter-defibrillator: a case report and review of literature

We reported an elderly female （76 years old） accompanied with paroxysmal atrial fibrillation （AF） who underwent the implantation of implantable cardioverter-defibrillator （ICD） due to ventricular tachycardia （VT） in our department. No peri-operative anticoagulation was given to her in consideration of risk for hemorrhage. The patient was found to have fever and abdominal pain at the 7th day after surgery, and then right renal infarction was confirmed after diagnosis. Then the patient was given standard anticoagulant therapy. In present, it is a controversial issue on the efficacy and safety of anticoagulation strategy during perioperation of implantation of cardiac rhythm device （CRD）. Renal infarction due to AF is relatively rare and the atypical clinical manifestations make early diagnosis for this patient more difficult. The revelation of this case includes：for patients with AF and high risk of stroke, anticoagulation therapy is necessary, but the strategy of anticoagulation remains controversial;for patients with AF and moderate risk of stroke, acute embolic infarction of abdominal organs should be taken into account when acute abdominal symptoms occur without anticoagulation.