心房颤动患者华法林抗凝治疗的管理现状

心房颤动(下称房颤)是临床最为常见的持续性心律失常,其主要危害是缺血性脑卒中。由于房颤并发脑卒中具有发病率高、致残率高、致死率高和复发率高的特点,使得抗凝治疗成为房颤患者治疗策略的重中之重。临床上最常用的口服抗凝药物是华法林,它能够显著降低房颤患者缺血性脑卒中的发生率。但由于该药治疗安全窗窄,半衰期长,与食物药物的相互作用明显,抗凝治疗需在严密监测国际标     

老年人房颤与NT-ProBNP、左房大小的关系及抗凝现状分析

目的观察老年人房颤与N-末端脑钠肽前体(NT-proBNP)及左房大小的关系,并分析其抗凝现状。方法对120例老年房颤患者的临床资料进行回顾性分析,包括初发、阵发、持续性、持久性、长期持续性房颤患者的NT-proBNP水平、左房内径和抗凝方法。结果 120例老年房颤患者中,初诊房颤占15.0%,阵发性房颤占30.0%,持续性房颤、持久性房颤、长期持续性房颤占55.0%。使用华法林抗凝治疗占41%,房颤发生脑栓塞占9.1%。持续性房颤、持久性房颤、长期持续性老年房颤的患者NT-proBNP明显高于阵发性、初诊房颤患者,其左房内径明显大于阵发性、初诊房颤患者的左房内径。抗凝治疗中华法林组栓塞事件发生率(2.08%)低于阿司匹林组(13.89%),而两组出血事件发生率无显著差异。结论持续性房颤、永久性房颤、长期持续性房颤在老年患者中占主导地位。房颤时间越长,左房内径越大,NT-proBNP也越高。华法林抗凝效果优于阿司匹林,且获益超过出血风险。     

阿托伐他汀在心房颤动患者中的应用及护理

目的:探讨阿托伐他汀对阵发性房颤或持续性房颤复律后的预防作用及护理方法。方法:将100例阵发性房颤或持续性房颤复律后患者随机分为治疗组与对照组各50例,两组均给予抗血小板药物、抗心律失常药物等常规治疗,治疗组在常规治疗基础上加用阿托伐他汀10 mg/d,对照组口服安慰剂,服药1年,随访1.5年。结果:治疗组阵发性房颤发作次数减少>50%比例高于对照组(P<0.05),阵发性房颤转为持续性或永久性房颤比例、持续性房颤复律后再发率、发生左房扩大者比例、血栓栓塞发生率均低于对照组(P<0.05);随访期间急性房颤发作患者治疗组使用胺碘酮复律剂量及电复律能量、次数均低于对照组(P<0.05)。结论:阿托伐他汀能有效预防或减少房颤发作,治疗期间护理人员应给予患者健康教育和心理疏导,可改善预后、提高生活质量。     

心房颤动治疗:现状和未来

心房颤动(房颤)是21世纪的心血管流行病,疾病负担日趋严重。华法林作为房颤卒中预防的有效药物,在我国房颤患者中的应用仍然不足。随着新型口服抗凝药和左心耳封堵技术应用的不断增加,房颤抗栓治疗面临着更多选择。导管消融是阵发性房颤治疗的一线选择,而持续房颤的最佳消融策略仍然存在争议。近年来,生活方式干预在房颤预防和治疗中的价值逐步受到重视。未来,房颤治疗将进入一个崭新的时代。     

心房颤动住院患者的临床特点及抗凝治疗

【目的】了解现阶段心房颤动(房颤)患者的流行病学变化、临床特征及抗凝治疗情况。【方法】对本院出院诊断为房颤有心脏超声资料的921例患者进行分析。【结果】①住院房颤患者中瓣膜性房颤占房颤病人总数的38.8%;非瓣膜性房颤占61.2%,病因以高血压病、冠心病、孤立性房颤、扩张型心肌病为主。②大于70岁房颤占30.3%,年龄越大房颤发生率越高。③左心房超声记录中左房增大(>40mm)占71.9%;约21.4%有左室射血分数降低;阵发性房颤369例(40.1%),持续性房颤552例(59.9%),持续性房颤患者左心房明显大于阵发性房颤患者(P<0.01)。④应用华发林抗凝治疗76例,仅占8.3%。【结论】非瓣膜性房颤已成为现阶段房颤的主要病因,年龄和高血压是房颤最常见的相关因素。应积极应用华发林抗凝治疗。     

心房颤动患者血浆高敏C反应蛋白水平的临床分析

目的检测心房颤动(简称房颤)患者血浆高敏C反应蛋白(简称hs-CRP)水平,进一步探讨炎症在房颤发生和维持中的作用,为房颤的药物治疗寻找新的可靠的靶点。方法临床诊断房颤的118例患者为研究对象,根据临床资料和心电图及动态心电图结果,分为阵发性房颤53例、持续性房颤65例。同时取经保健科体检为健康人的35例作为对照组;抽取外周血,用美国德灵BN-100全自动特定蛋白分析仪通过免疫散射比浊法测定hs-CRP水平。全部数据采用SPSS 19.0软件包进行统计学分析。结果 (1)房颤组hs-CRP的水平明显高于对照组(P<0.05),持续性房颤组与阵发性房颤组hs-CRP的水平均高于对照组(P<0.05);持续性房颤组hs-CRP的水平高于阵发性房颤组(P<0.05);(2)hs-CRP的水平与左心房直径(LADs)有正相关关系(r=0.425,P<0.05)。结论房颤患者hs-CRP的水平均明显高,且与房颤的持续状态有关,提示炎症反应在房颤的发生、发展中起重要作用,抗感染治疗有可能成为药物治疗的新靶点。     

单中心心房颤动患者流行病学特点和抗凝治疗现状分析

目的 分析区域内单中心房颤人群流行病特点及抗凝现状。方法 收集2019年12月至2021年6月期间就诊于石河子市人民医院的房颤患者702例,随访半年(出院1、3和6个月),分析人群流行病学特点、栓塞/出血风险评估(CHA2DS2-VASc/HAS-BLED评分)分布特征、随访6个月时新发事件(急性冠脉事件、急性心力衰竭、新发脑血管病、出血事件、血栓事件、再次住院、死亡)的发生率,以及影响抗凝治疗的主要因素。结果 1)702例房颤患者平均年龄(73.96±11.27)岁,男352例、女350例,常见伴随疾病有高血压(38.89%)、冠心病(50.57%)、心力衰竭(49.19%)、心脏瓣膜病(1.42%)、糖尿病(56.27%),主要以阵发性房颤(40.02%)和永久性房颤(31.19%)为主,房颤人群总体抗凝率为64.10%;CHA2DS2-VASc评分≥2分人群中,未口服抗凝药物患者224例(占总房颤人群31.91%),口服抗凝药物患者425例(占总房颤人群60.54)。702例患者中使用华法林抗凝患者112例(15.60%)、新型抗凝药物(NOAC,包括利伐沙班、达比加群酯和艾多沙班)338例(48.15%),本地区房颤人群服用抗凝药物种类以NOAC为主。2)对口服华法林抗凝人群随访半年,发现自行停用华法林抗凝药物的患者13例(10.66%),在出院1、3个月时国际标准化比值(INR)达标率最高(59.82%、73.21%),出院6个月时INR达标率下降至58.93%。3)随访半年中,记录到新发脑血管疾病4例,其中未抗凝组3例、抗凝组1例;栓塞事件2组均为1例;再住院分别为17例、13例;死亡分别为3例、2例。结论 本地区房颤好发于老年人,抗凝率总体良好,多数患者以口服NOAC为主;出院6个月时患者华法林INR达标率明显下降。     

中药医治疗心房颤动的研究现状及展望

<正>心房颤动(Atrial Fibrillation, AF)简称房颤,是一种由心房出现不协调激动所致的心房无效收缩的室上性快速性心律失常。传统房颤分为首发房颤、持续性房颤、阵发性房颤、长程持续性房颤、永久性房颤五种。当今,导管消融术、起搏器植入及各类抗心律失常的药物被广泛用于房颤的治疗,但存在疗     

不同类型心房颤动患者凝血标志物的临床研究

目的:研究阵发性、持续性及永久性房颤患者血中凝血标志物浓度的改变及临床意义.方法:对2006年1月至2008年12月收治的101例房颤患者分为阵发性房颤组36例、持续性房颤组32例、永久性房颤组33例,并选取同期体检的健康人30例为对照组,分别测定血中血浆纤维蛋白原、D-二聚体、血管性血友病因子、血小板膜糖蛋白Ⅱ b/Ⅲa浓度并进行比较.结果:持续性及永久性房颤组各项指标均显著高于阵发性房颤组和对照组,P<0.05;阵发性房颤组与对照组间、持续性房颤组与永久性房颤组间各指标均无显著性差异,P>0.05.结论:持续性与永久性房颤患者血中凝血指标增加,处于血栓前状态,应给予积极抗凝治疗;而阵发性房颤患者血中凝血指标无明显增加.     

器质性心脏病心房颤动患者的药物治疗

心房颤动(房颤)是临床常见的心律失常之一,致残、致死率高。房颤的治疗策略包括抗凝预防血栓栓塞、转复和维持窦性心律、心室率控制,药物治疗是房颤治疗的基础,但器质性心脏病合并房颤的处理有其特殊性,本文对器质性心脏病合并房颤的药物治疗予以综述。     

Catheter ablation of persistent and permanent atrial fibrillation: Bordeaux experience

The seminal observation that ectopics from the pulmonary veins may initiate paroxysmal atrial fibrillation (AF) heralded an era of potentially curative catheter ablation therapy for AF. In recent years, catheter ablation has been performed for not only paroxysmal but also persistent and permanent AF. It is anticipated that the number of procedures will continue to increase and the indication for catheter ablation will expand. This article details our experience with catheter ablation therapy for patients with persistent and chronic AF.     

Catheter ablation of persistent and permanent atrial fibrillation: Bordeaux experience

The seminal observation that ectopics from the pulmonary veins may initiate paroxysmal atrial fibrillation (AF) heralded an era of potentially curative catheter ablation therapy for AF. In recent years, catheter ablation has been performed for not only paroxysmal but also persistent and permanent AF. It is anticipated that the number of procedures will continue to increase and the indication for catheter ablation will expand. This article details our experience with catheter ablation therapy for patients with persistent and chronic AF.     

Unanswered Questions in Complex Fractionated Atrial Electrogram Ablation

Pulmonary vein isolation has been accepted as potential target for ablation of paroxysmal atrial fibrillation (AF) given that the pulmonary veins are the main source of AF triggers. However, ablation strategies for persistent AF are less well defined. Mapping and ablation of complex fractionated atrial electrograms (CFAEs) is one strategy that has been proposed as a strategy for substrate modification although there is no consensus on their definition and procedural end points. Results of clinical studies have been conflicting. In this review, we aimed to discuss yesterday, today, and tomorrow of CFAEs ablation in persistent AF ablation.     

Characteristics in image integration system guiding catheter ablation of atrial fibrillation with a common ostium of inferior pulmonary veins

BACKGROUND: Common ostium of the inferior pulmonary veins (PVs) is a kind of unusual variation in pulmonary venous drainage to the left atrium (LA), whose feature of anatomy, electrophysiology, and catheter ablation is rarely demonstrated, and the consecutive series of research for catheter ablation of atrial fibrillation (AF) in patients with that anomaly have not been reported. METHODS: A total of 1,226 patients with drug-refractory AF received magnetic resonance angiography (MRA) or multidetector computed tomography (MDCT) scan before ablation. Electrophysiological mapping was used to detect the focal triggers in paroxysmal AF. Basic catheter ablation strategy was circumferential PV isolation with "tricircle" under the guidance of image integration system: two circles surround two superior PVs, and the other surround the common trunk. RESULTS: LA and PVs reconstruction by image integration system showed a common pulmonary venous ostium of the right and left inferior PVs before ablation in 11 patients (0.9%). This anomaly could be classified into two types: type A without a short common trunk of inferior PVs and type B with a short common trunk. Fifty-seven percent paroxysmal AF was revealed focal triggers in the common ostium. The success rate of that strategy was 90%. CONCLUSION: Common ostium of inferior PVs could be classified into two types according to the presence of a short common trunk or not. The common ostium was usually an important triggering focus in paroxysmal AF. Catheter ablation strategy of circumferential PV isolation with "tricircle" under the guidance of image integration system would be a good choice.     

Termination of long-lasting persistent versus short-lasting persistent and paroxysmal atrial fibrillation by ablation

Background: Left atrial (LA) structures for the maintenance of different atrial fibrillation (AF) forms are not uniform. The incidence, electrophysiological patterns, and LA sites of sinus rhythm (SR) restoration during ablation of different AF forms were evaluated. Methods: One hundred patients with long‐lasting persistent AF were retrospectively compared to 35 patients with short‐lasting persistent AF and 59 patients with a sustained episode of paroxysmal AF. All patients underwent a first ablation using a stepwise ablation approach with the endpoint of SR restoration by ablation. Results: SR was restored in 38%, 83%, and 97% of patients with long‐lasting persistent, short‐lasting persistent, and paroxysmal AF, respectively (P <0.001 for long‐lasting persistent vs paroxysmal AF; P = 0.02 for long‐lasting persistent vs short‐lasting persistent AF). When modes and sites of SR restoration were evaluated among the patients with long‐lasting persistent, short‐lasting persistent, and paroxysmal AF, SR was restored via conversion into LA tachycardia in 79%, 52%, and 4% of patients (P <0.001 for long‐lasting persistent vs paroxysmal AF); by the pulmonary vein encircling in 8%, 24%, and 93% patients (P <0.001 for long‐lasting persistent vs paroxysmal AF); and by ablation at the LA anterior wall or inside the coronary sinus in 66%, 45%, and 2% patients (P <0.001 for long‐lasting persistent and paroxysmal AF). During the 31 ± 14 month follow‐up since the first ablation, of the 50 patients with long‐term SR maintenance (38 patients free of class I or III antiarrhythmic drugs), SR was restored by ablation in 29 (58%) patients versus nine (18%) patients out of 50 patients with unsuccessful clinical outcome (P = 0.009). Conclusion: Ablation of long‐lasting persistent AF was characterized by more frequent failure to restore SR, and predominant conversion into LA tachycardia prior to SR restoration, and SR restoration by ablation outside the LA posterior wall. SR restoration by ablation was associated with better clinical outcome in these patients.     

Atrial fibrillation management: evaluating rate vs rhythm control

Atrial fibrillation (AF) is an increasing global issue leading to increased hospitalizations, adverse health related events and mortality. This review focuses on the management of atrial fibrillation, in particular in the past decade, comparing two major strategies, rate or rhythm control. We evaluate the evidence for each strategy, pharmacological options and the increasing utilization of invasive techniques, in particular catheter ablation and use of implantable cardiac pacing devices. Pharmacological comparative trials evaluating both strategies have shown rate control being non-inferior to rhythm control for clinical outcomes of mortality and other cardiovascular events (including stroke). Catheter ablation techniques, involving radiofrequency ablation and recently cryoablation, have shown promising results in particular with paroxysmal AF. However, persistent AF provides ongoing challenges and will be a particular focus of continued research.     

Long-Term Results of Hybrid Therapy in Patients with Atrial Fibrillation Who Develop Atrial Flutter During Flecainide Infusion

The flecainide infusion test has been proposed to screen candidates for hybrid pharmacological and ablation therapy. We report the long-term follow-up of 154 consecutive patients with paroxysmal or persistent atrial fibrillation (AF) who developed atrial flutter (AFL) during flecainide infusion (IC AFL), treated with inferior vena cava-tricuspid annulus isthmus catheter ablation and oral flecainide (hybrid therapy). Over a mean of 54.1 ± 13.1 months 82 patients (53%) remained free of AF and AFL. Flecainide was discontinued because of adverse effects in 6 patients (4%). A history of persistent AF, and the documentation of ≥1 spontaneous AFL episode before the flecainide test were independent predictors of successful hybrid therapy. In patients with paroxysmal AF without documented spontaneous AFL, the long-term efficacy of hybrid therapy was 38.5% (P = 0.03). The flecainide infusion test reliably detects candidates for hybrid therapy. The efficacy of this therapy is maintained over the long-term with a high patient compliance.     

Atrial Tachycardias Encountered in the Context of Catheter Ablation for Atrial Fibrillation Part II: Mapping and Ablation

Over the past decade, there has been an exponential increase in the number of catheter ablation procedures performed for atrial fibrillation (AF). While for paroxysmal AF, proximal pulmonary vein isolation is sufficient in the majority of cases, ablation of persistent and longstanding AF requires an extensive surgical-like procedure. This approach is correlated with a high rate of AF termination; however, this is achieved at the cost of at least one atrial tachycardia (AT) during the index procedure or during the patient's follow-up in the vast majority of cases. As these ATs are often multiple, complex, and frequently more symptomatic than AF, they constitute the last and frequently the most difficult step in ablation for patients with persistent AF. This review concentrates on the practical approaches to the treatment of AT in the context of AF ablation and provides an algorithm that aims at facilitating mapping and ablation strategies using conventional electrophysiological tools .     

Significance of Late Recurrence of Atrial Fibrillation during Long-Term Follow-Up after Pulmonary Vein Isolation

Background and Study Objective : Patients with paroxysmal or persistent atrial fibrillation (AF) can be treated by pulmonary vein (PV) isolation. Although the recurrence rate after the procedure is relatively high, the long-term outcomes after initially recurrence-free procedures remains unclear. We examined the rates of recurrence of AF after PV isolation.
Methods: Our study included 278 consecutive patients with drug-refractory AF (mean age = 53 ± 11 years, 228 men). PV isolation was based on the disappearance of PV potentials recorded from a circumferential catheter after segmental ostium ablation. Cavo-tricuspid isthmus lines and additional atrial lines were performed in 124 and 28 patients, respectively. Patients were monitored for a mean of 26 ± 11 months (range 12–56). Recurrence was defined as ≥1 episodes of symptomatic or asymptomatic AF >1 month after the procedure.
Results: A total of 120 (34) patients had ≥1 recurrence of AF >1 month after the procedure, of whom 14 (4) had a first recurrence >6 months after the procedure. There was a significantly higher recurrence rate among patients with persistent AF.
Conclusions : A relatively high AF recurrence rate was observed after PV isolation. AF may recur late after the ablation procedure, though the majority of recurrences occurred within 6 months after the first procedure. There were no differences in incidence or time of occurrence of late recurrences between patients with paroxysmal versus persistent AF.